Impact of payment method on behaviour of primary care physicians: a systematic review.
Impact of payment method on behaviour of primary care physicians: a systematic review.
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DOI：
10.1258/1355819011927198
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发表时间：
2001-01-01
影响因子：
2.4
通讯作者：
Pedersen, L
中科院分区：
文献类型：
--
作者：
Gosden, T;Forland, F;Pedersen, L
目的：为了审查支付系统对初级保健physics.METHODS的行为的影响：所有的随机试验，控制之前和之后的研究，并中断时间序列研究，比较人头，工资，收费服务或目标支付（混合或单独），确定由计算机检索的文献。方法学质量评估和数据提取由两名评审员使用数据核对表独立进行。结果：6篇文献符合纳入标准。在报告质量、研究背景和衡量的结果范围方面存在相当大的差异。按服务收费导致提供的初级保健服务数量高于按人头收费，但对二级保健服务数量影响的证据喜忧参半。收费服务导致更多的病人访问，更大的连续性的护理，更高的遵守建议的访问次数，但较低的病人满意度与获得医生相比，工资支付。目标支付对免疫率的影响的证据是inconclusions.CONCLUSIONS：有一些证据表明，一个初级保健医生是如何支付影响他/她的行为，但这些研究的普遍性是未知的。支付系统领域的大多数政策变化都没有充分地从研究中得到信息。医生支付系统的未来变化需要严格评估。
OBJECTIVE: To review the impact of payment systems on the behaviour of primary care physicians.METHODS: All randomised trials, controlled before and after studies, and interrupted time series studies that compared capitation, salary, fee-for-service or target payments (mixed or separately) that were identified by computerised searches of the literature. Methodological quality assessment and data extraction were undertaken independently by two reviewers using a data checklist. Study results were qualitatively analysed.RESULTS: Six studies met the inclusion criteria. There was considerable variation in the quality of reporting, study setting and the range of outcomes measured. Fee-for-service resulted in a higher quantity of primary care services provided compared with capitation but the evidence of the impact on the quantity of secondary care services was mixed. Fee-for-service resulted in more patient visits, greater continuity of care, higher compliance with a recommended number of visits, but lower patient satisfaction with access to a physician compared with salary payment. The evidence of the impact of target payment on immunisation rates was inconclusive.CONCLUSIONS: There is some evidence to suggest that how a primary care physician is paid does affect his/her behaviour but the generalisability of these studies is unknown. Most policy changes in the area of payment systems are inadequately informed by research. Future changes to doctor payment systems need to be rigorously evaluated.