PRIMARY CARE: Payment Method Doesn’t Affect Use, Cost
A study in this week's Journal of the American Medical Association found that how primary care physicians (PCPs) in medical groups are compensated does not impact managed care enrollees' use or cost of care. Looking at various compensation arrangements -- salary only, production-based or mixed systems --researchers at the University of Washington found that the "impact of PCP compensation on use and cost was statistically insignificant." In addition, the authors write that "[t]ests for interactions between compensation method and health plan payment and between compensation method and group size revealed no statistically significant interactions." Instead, the researchers found that the "principal drivers of use and cost were characteristics of individual enrollees and their PCPs and the level of health plan benefit coverage." They note that "[u]se and cost increased with age, female gender, and richness-of-plan benefit coverage," findings that they contend "are not surprising and are consistent with earlier studies of health services utilization." The results were based on a survey of 865 primary care doctors practicing in 60 medical groups in Washington state.
We Told You So
The authors note that their findings are in line "with the statements of PCPs and administrators in key informant interviews." They write that primary care doctors "reported that their treatment decisions were based on clinical indications rather than financial incentives." Doctors "do respond to incentives and how they are compensated is perceived to affect their productivity, but not their treatment decisions for individual patients," they conclude (Conrad et al, 3/18 issue). Click here to view an abstract of this study.