Physician remuneration methods: the need for change and flexibility
Charles J. Wright, MB, MSc, FRCSC
Canadian Medical Association Journal 1996; 154: 678-680
Dr. Wright is vice-president of medical affairs, Vancouver Hospital and Health Sciences Centre, and clinical professor of health care and epidemiology, University of British Columbia, Vancouver, BC.
Paper reprints of the full text may be obtained from: Dr. Charles J. Wright, Vice-president, Medical Affairs, Vancouver Hospital and Health Sciences Centre, 855 West 12th Ave., Vancouver BC V5Z 1M9; fax 604 875-4964; cwright@van.hospital.ubc.ca
Abstract
Although fee-for-service payment may create an incentive for some physicians to make inappropriate clinical decisions that will maximize income, physicians are no more prone to this kind of behaviour than other professionals. Remuneration methods do not necessarily have a predictable effect upon practice, as shown by Hutchison and associates' report in this issue (see pages 653 to 661) that the capitation system used by Health Service Organizations in Ontario has not had the intended effect of reducing hospital utilization. However, many essential activities performed by physicians do not fit in a fee-for-service system. The real challenge is to achieve flexibility and balance in any payment system to correct the prevailing gross inequities between different areas of practice and to ensure that disincentives for activities such as health promotion and health service evaluation are eliminated.
| CMAJ March 1, 1996 (vol 154, no 5) |