FINANCIAL INCENTIVES FOR PHYSICIANS IN HMOS - IS THERE A CONFLICT OF INTEREST
FINANCIAL INCENTIVES FOR PHYSICIANS IN HMOS - IS THERE A CONFLICT OF INTEREST
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DOI：
10.1056/nejm198712313172725
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发表时间：
1987-12-31
影响因子：
158.5
通讯作者：
HILLMAN, AL
中科院分区：
文献类型：
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作者：
HILLMAN, AL
健康维护组织（HMOs）使用经济激励来限制医疗资源的使用，这是否代表了医生对收入的关注与他们对患者的关注之间的利益冲突？为了探讨初级保健医生在HMOs的合同义务，我邮寄了一份调查，以所有595 HMOs已知的操作，截至1986年6月。595家健康维护组织中有302家（51%）做出了回应，67%的资本金计划和82%的服务收费计划都保留了一定比例的医生收入以应对潜在的赤字，但只有21%的受薪医生计划这样做。30%的HMO除了这种扣留外还有其他处罚。18%的HMO根据个别医生的经验而不是一组医生的集体经验来返还扣留的金额。营利性HMO不太可能使用基于工资的支付，更有可能扣留一定比例的收入，更有可能根据个人医生的经验来返还这笔扣留的金额。大多数健康维护组织都有与参与医生分享盈余的机制。我的结论是，健康维护组织的合同安排差异很大。某些财务激励措施，特别是当两者结合使用时，会产生利益冲突，可能会影响医生的行为，并对护理质量产生不利影响。
Do financial incentives used by health maintenance organizations (HMOs) to restrain the use of health care resources represent a conflict of interest between physicians' concern about their income and their concern about patients? To explore the contractual obligations of primary care physicians in HMOs, I mailed a survey to all 595 HMOs known to be in operation as of June 1986. In all, 302 of 595 HMOs (51 percent) responded.Sixty-seven percent of plans with capitation-based arrangements and 82 percent of plans with fee-for-service arrangements withhold a percentage of their physicians' income against potential deficits, but only 21 percent of plans with salaried physicians do so. Thirty percent of HMOs have other penalties in addition to this withholding. Eighteen percent of HMOs base the return of the withheld amount on the experience of individual physicians rather than on the collective experience of a group of physicians. For-profit HMOs are less likely to use salary-based payment, more likely to withhold a percentage of income, and more likely to base the return of this withheld amount on the experience of individual physicians. Most HMOs have mechanisms for sharing surpluses with participating physicians.I conclude that contractual arrangements in HMOs vary widely. Certain financial incentives, especially when used in combination, suggest conflicts of interest that may influence physicians' behavior and adversely affect the quality of care.