Money matters - primary care providers' perceptions of payment incentives.
GPs
Incentives
Interview study
Payments
Primary care
Sweden
Journal
Journal of health organization and management
ISSN: 1758-7247
Titre abrégé: J Health Organ Manag
Pays: England
ID NLM: 101179473
Informations de publication
Date de publication:
02 Feb 2021
02 Feb 2021
Historique:
entrez:
1
2
2021
pubmed:
2
2
2021
medline:
29
10
2021
Statut:
ppublish
Résumé
Payments to healthcare providers create incentives that can influence provider behaviour. Research on unit-level incentives in primary care is, however, scarce. This paper examines how managers and salaried physicians at Swedish primary healthcare centres perceive that payment incentives directed towards the healthcare centre affect their work. An interview study was conducted with 24 respondents at 13 primary healthcare centres in two cities, located in regions with different payment systems. One had a mixed system comprised of fee-for-service and risk-adjusted capitation payments, and the other a mainly risk-adjusted capitation system. Findings suggested that both managers and salaried physicians were aware of and adapted to unit-level payment incentives, albeit the latter sometimes to a lesser extent. Respondents perceived fee-for-service payments to stimulate production of shorter visits, up-coding of visits and skimming of healthier patients. Results also suggested that differentiated rates for patient visits affected horizontal prioritisations between physician and nurse visits. Respondents perceived that risk-adjustments for diagnoses led to a focus on registering diagnosis codes, and to some extent, also up-coding of secondary diagnoses. Policymakers and responsible authorities need to design payment systems carefully, balancing different incentives and considering how and from where data used to calculate payments are retrieved, not relying too heavily on data supplied by providers. This study contributes evidence on unit-level payment incentives in primary care, a scarcely researched topic, especially using qualitative methods.
Identifiants
pubmed: 33522211
doi: 10.1108/JHOM-06-2020-0225
doi:
Types de publication
Journal Article
Langues
eng
Informations de copyright
© Emerald Publishing Limited.
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