Physician Incentive Programs: Is it Possible to Develop Incentive Programs that Provide Financial Incentives for Primary Care Physicians while Balancing Quailty Medicine and Utilization Controls?

[摘要] Managed care organizations have focused on utilization controls through the use of managed care techniques as a manner of containing costs. Managed care techniques such as selective contracting, risk sharing and risk adjustment, gatekeepers, medical management and utilization review have presented a more measurable means o f financially incentivizing the primary care physician. However, has the focus on utilization controls been at the expense of practicing quality care medicine?

Compensation that rewards physicians for withholding care can interfere with physicians’ loyalty to patients and ultimately their candor and trust. Structural incentives to reduce cost can be effective if they are not so direct and substantial to influen ce medical decisions. Thoughtful incentive structures can use measures o f quality and patient satisfaction instead o f rewarding less costly treatment decisions. How do we develop and balance these incentive structures and what other issues need to be taken into consideration?

Thus, in order to find a solution for such a complex issue, the complexity needs to be analyzed and defined. My research will utilize information already available on utilization controls and quality incentives to help better understand the existing relationships and structure. Additionally, my research will include gathering and analyzing data on two existing quality incentive programs to determine the effectiveness o f using financial incentives for practicing quality medicine. The findings o f this research will provide health care administrators with a cost / benefit analysis of the development of similar and more extensive models.

[发布机构] University of Michigan

[效力级别] health care cost

[关键词] health maintenance organization (HMO);health care cost;primary care physician;incentives;managed care;College of Arts and Sciences: Public Administration