Theory and practice in the design of physician payment incentives
Theory and practice in the design of physician payment incentives
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DOI：
10.1111/1468-0009.00202
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发表时间：
2001-01-01
影响因子：
6.6
通讯作者：
Robinson, JC
中科院分区：
文献类型：
--
作者：
Robinson, JC
将委托代理关系的经济学文献与市场创新的例子相结合，可以分析支付医生费用的方法的演变。代理理论和基于绩效的薪酬的经济原理适用于信息不完全、风险规避、多个相互关联的任务和团队生产效率的背景。按服务收费和按人头付费是激励医生实现特定目标的有缺陷的方法。融合按服务收费、按人头付费和案件费率等要素的支付创新可以保留各自的优势并削弱各自的劣势。这些创新包括按服务收费的按人头付费、按服务收费或“接触”按人头付费的部门预算以及特定疾病发作的病例率。支付激励的背景包括筛选和监督等非价格机制以及雇佣和所有权等组织关系。该分析对卫生服务研究和有关医生付费激励的公共政策具有影响。
Combining the economic literature on principal-agent relationships with examples of marketplace innovations allows analysis of the evolution of methods for paying physicians. Agency theory and the economic principles of performance-based compensation are applied in the context of imperfect information, risk aversion, multiple interrelated tasks, and team production efficiencies. Fee-for-service and capitation are flawed methods of motivating physicians to achieve specific goals. Payment innovations that blend elements of fee-for-service, capitation, and case rates can preserve the advantages and attenuate the disadvantages of each. These innovations include capitation with fee-for-service carve-outs, department budgets with individual fee-for-service or "contact" capitation, and case rates for defined episodes of illness. The context within which payment incentives are embedded, includes such nonprice mechanisms as screening and monitoring and such organizational relationships as employment and ownership. The analysis has implications for health services research and public policy with respect to physician payment incentives.