Tags

Type your tag names separated by a space and hit enter

Perceived financial incentives, HMO market penetration, and physicians' practice styles and satisfaction.
Health Serv Res. 1999 Apr; 34(1 Pt 2):307-21.HS

Abstract

OBJECTIVE

To estimate the effects of physicians' personal financial incentives and other measures of involvement with HMOs on three measures of satisfaction and practice style: overall practice satisfaction, the extent to which prior expectations about professional autonomy and the ability to practice good-quality medicine are met, and several specific measures of practice style.

DATA SOURCES

A telephone survey conducted in 1997 of 1,549 physicians who were located in the 75 largest Metropolitan Statistical Areas in 1991. Eligible physicians were under age 52, had between 8 and 17 years of post-residency practice experience, and spent at least 20 hours per week in patient care. The response rate was 74 percent.

STUDY DESIGN

Multivariate binomial and multinomial ordered logistic regression models were estimated. Independent variables included physicians' self-reported financial incentives, measured by the extent to which their overall financial arrangements created an incentive to either reduce or increase services to patients, the level of HMO penetration in the market, employment setting, medical specialty, exposure to managed care while in medical training, and selected personal characteristics.

PRINCIPAL FINDINGS

About 15 percent of survey respondents reported a moderate or strong incentive to reduce services; 70 percent reported a neutral incentive; and 15 percent reported an incentive to increase services. Compared to physicians with a neutral incentive, physicians with an incentive to reduce services were from 1.5 to 3.5 times more likely to be very dissatisfied with their practices and were 0.2 to 0.5 times as likely to report that their expectations regarding professional autonomy and ability to practice good-quality medicine were met. They were also 0.2 to 0.6 times as likely to report having the freedom to care for patients the way they would like along several specific measures of practice style, such as sufficient time with patients, ability to hospitalize, ability to order tests and procedures, and ability to make referrals. These effects were generally reinforced by practicing in an area with a high level of HMO penetration and were offset to some extent by having had exposure to HMOs and the practice of cost-effective medicine while in medical training.

CONCLUSIONS

Although financial incentives to reduce services are not widespread, there is a legitimate reason to be concerned about possible adverse affects on the quality of care. More research is needed to investigate directly whether changes in patients' health are affected by their physicians' financial incentives.

Authors+Show Affiliations

Institute for Health Care Research and Policy, Georgetown University Medical Center, Washington, DC 20007, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

10199677

Citation

Hadley, J, et al. "Perceived Financial Incentives, HMO Market Penetration, and Physicians' Practice Styles and Satisfaction." Health Services Research, vol. 34, no. 1 Pt 2, 1999, pp. 307-21.
Hadley J, Mitchell JM, Sulmasy DP, et al. Perceived financial incentives, HMO market penetration, and physicians' practice styles and satisfaction. Health Serv Res. 1999;34(1 Pt 2):307-21.
Hadley, J., Mitchell, J. M., Sulmasy, D. P., & Bloche, M. G. (1999). Perceived financial incentives, HMO market penetration, and physicians' practice styles and satisfaction. Health Services Research, 34(1 Pt 2), 307-21.
Hadley J, et al. Perceived Financial Incentives, HMO Market Penetration, and Physicians' Practice Styles and Satisfaction. Health Serv Res. 1999;34(1 Pt 2):307-21. PubMed PMID: 10199677.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Perceived financial incentives, HMO market penetration, and physicians' practice styles and satisfaction. AU - Hadley,J, AU - Mitchell,J M, AU - Sulmasy,D P, AU - Bloche,M G, PY - 1999/4/13/pubmed PY - 1999/4/13/medline PY - 1999/4/13/entrez SP - 307 EP - 21 JF - Health services research JO - Health Serv Res VL - 34 IS - 1 Pt 2 N2 - OBJECTIVE: To estimate the effects of physicians' personal financial incentives and other measures of involvement with HMOs on three measures of satisfaction and practice style: overall practice satisfaction, the extent to which prior expectations about professional autonomy and the ability to practice good-quality medicine are met, and several specific measures of practice style. DATA SOURCES: A telephone survey conducted in 1997 of 1,549 physicians who were located in the 75 largest Metropolitan Statistical Areas in 1991. Eligible physicians were under age 52, had between 8 and 17 years of post-residency practice experience, and spent at least 20 hours per week in patient care. The response rate was 74 percent. STUDY DESIGN: Multivariate binomial and multinomial ordered logistic regression models were estimated. Independent variables included physicians' self-reported financial incentives, measured by the extent to which their overall financial arrangements created an incentive to either reduce or increase services to patients, the level of HMO penetration in the market, employment setting, medical specialty, exposure to managed care while in medical training, and selected personal characteristics. PRINCIPAL FINDINGS: About 15 percent of survey respondents reported a moderate or strong incentive to reduce services; 70 percent reported a neutral incentive; and 15 percent reported an incentive to increase services. Compared to physicians with a neutral incentive, physicians with an incentive to reduce services were from 1.5 to 3.5 times more likely to be very dissatisfied with their practices and were 0.2 to 0.5 times as likely to report that their expectations regarding professional autonomy and ability to practice good-quality medicine were met. They were also 0.2 to 0.6 times as likely to report having the freedom to care for patients the way they would like along several specific measures of practice style, such as sufficient time with patients, ability to hospitalize, ability to order tests and procedures, and ability to make referrals. These effects were generally reinforced by practicing in an area with a high level of HMO penetration and were offset to some extent by having had exposure to HMOs and the practice of cost-effective medicine while in medical training. CONCLUSIONS: Although financial incentives to reduce services are not widespread, there is a legitimate reason to be concerned about possible adverse affects on the quality of care. More research is needed to investigate directly whether changes in patients' health are affected by their physicians' financial incentives. SN - 0017-9124 UR - https://www.unboundmedicine.com/medline/citation/10199677/Perceived_financial_incentives_HMO_market_penetration_and_physicians'_practice_styles_and_satisfaction_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/10199677/ DB - PRIME DP - Unbound Medicine ER -