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Physicians' perceptions of the effect on clinical services of an alternative funding plan at an academic health sciences centre.
CMAJ. 1999 Jun 15; 160(12):1710-4.CMAJ

Abstract

BACKGROUND

In July 1994 an alternative funding plan for clinical services (global funding instead of fee-for-service payment) was established at the Southeastern Ontario Health Sciences Centre, Kingston, Ont. This study describes the perceptions of the referring physicians and consultants of the effects of the alternative funding plan 2.5 years after it was initiated.

METHODS

A questionnaire was mailed to all physicians in the Kingston area in November 1996. Information was collected on demographics, referring physicians' perceptions of the funding plan's impact on their practices, consultants' perceptions of its impact on their activities, perceptions of referring and consultant physicians of its impact on services provided by consultants, and attitudes toward alternative funding in the context of the Ontario health care system.

RESULTS

Of the 772 physicians 531 (68.8%) returned a completed questionnaire (323 referring physicians and 208 consultants). A sizeable proportion of the referring physicians (126 [39.0%]) indicated that they were referring fewer patients to consultants at the study centre. They did not think that their practice volume had increased, but they did report spending more time on complex cases and on patient care after referral or hospital stay, and more time coordinating community care after hospital stay. Of the consultants 81 (38.9%) believed that their time spent on patient care had increased. No consistent impact on time spent on research or teaching activities was perceived. A total of 54 (26.0%) of the consultants were concerned about the impact of the alternative funding plan on quality of care. A significant proportion of the respondents (399 [75.1%]) believed that outpatient waiting times had increased, and 116 (35.9%) of the referring physicians believed that consultants were not as available by telephone. Most (220 [68.1%]) of the referring physicians believed that the funding change had had a negative effect on health care services in the region, and 87 (41.8%) of the consultants agreed. Nevertheless, the respondents believed that other factors such as funding cuts, hospital bed closures and staff layoffs were much more responsible than the alternative funding plan for their negative perceptions.

INTERPRETATION

The alternative funding plan appears to have had an impact on the practices of individual physicians. However, it was not the focus for significant opposition or support from either consultants participating in the funding plan or referring physicians.

Authors+Show Affiliations

Department of Family Medicine, Queen's University, Kingston, Ont. godwinm@post.queensu.caNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10410632

Citation

Godwin, M, et al. "Physicians' Perceptions of the Effect On Clinical Services of an Alternative Funding Plan at an Academic Health Sciences Centre." CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, vol. 160, no. 12, 1999, pp. 1710-4.
Godwin M, Shortt S, McIntosh L, et al. Physicians' perceptions of the effect on clinical services of an alternative funding plan at an academic health sciences centre. CMAJ. 1999;160(12):1710-4.
Godwin, M., Shortt, S., McIntosh, L., & Bolton, C. (1999). Physicians' perceptions of the effect on clinical services of an alternative funding plan at an academic health sciences centre. CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, 160(12), 1710-4.
Godwin M, et al. Physicians' Perceptions of the Effect On Clinical Services of an Alternative Funding Plan at an Academic Health Sciences Centre. CMAJ. 1999 Jun 15;160(12):1710-4. PubMed PMID: 10410632.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Physicians' perceptions of the effect on clinical services of an alternative funding plan at an academic health sciences centre. AU - Godwin,M, AU - Shortt,S, AU - McIntosh,L, AU - Bolton,C, PY - 1999/7/20/pubmed PY - 1999/7/20/medline PY - 1999/7/20/entrez SP - 1710 EP - 4 JF - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne JO - CMAJ VL - 160 IS - 12 N2 - BACKGROUND: In July 1994 an alternative funding plan for clinical services (global funding instead of fee-for-service payment) was established at the Southeastern Ontario Health Sciences Centre, Kingston, Ont. This study describes the perceptions of the referring physicians and consultants of the effects of the alternative funding plan 2.5 years after it was initiated. METHODS: A questionnaire was mailed to all physicians in the Kingston area in November 1996. Information was collected on demographics, referring physicians' perceptions of the funding plan's impact on their practices, consultants' perceptions of its impact on their activities, perceptions of referring and consultant physicians of its impact on services provided by consultants, and attitudes toward alternative funding in the context of the Ontario health care system. RESULTS: Of the 772 physicians 531 (68.8%) returned a completed questionnaire (323 referring physicians and 208 consultants). A sizeable proportion of the referring physicians (126 [39.0%]) indicated that they were referring fewer patients to consultants at the study centre. They did not think that their practice volume had increased, but they did report spending more time on complex cases and on patient care after referral or hospital stay, and more time coordinating community care after hospital stay. Of the consultants 81 (38.9%) believed that their time spent on patient care had increased. No consistent impact on time spent on research or teaching activities was perceived. A total of 54 (26.0%) of the consultants were concerned about the impact of the alternative funding plan on quality of care. A significant proportion of the respondents (399 [75.1%]) believed that outpatient waiting times had increased, and 116 (35.9%) of the referring physicians believed that consultants were not as available by telephone. Most (220 [68.1%]) of the referring physicians believed that the funding change had had a negative effect on health care services in the region, and 87 (41.8%) of the consultants agreed. Nevertheless, the respondents believed that other factors such as funding cuts, hospital bed closures and staff layoffs were much more responsible than the alternative funding plan for their negative perceptions. INTERPRETATION: The alternative funding plan appears to have had an impact on the practices of individual physicians. However, it was not the focus for significant opposition or support from either consultants participating in the funding plan or referring physicians. SN - 0820-3946 UR - https://www.unboundmedicine.com/medline/citation/10410632/Physicians'_perceptions_of_the_effect_on_clinical_services_of_an_alternative_funding_plan_at_an_academic_health_sciences_centre_ DB - PRIME DP - Unbound Medicine ER -