How does changing capitation share impact service provision in mixed reimbursement environments?

There has been much research showing that fee-for-service (FFS) leads to increased provision of medical services and capitation leads to decreased provision of medical services. My own research shows that there are system-wide effects and that the impact of capitation for primary care physicians on services may depend on whether specialists are also reimbursed via…

FFS vs. Capitation Reimbursement: Responses by Physicians and Medical Students

How do people respond to financial incentives?  In the medical world, physicians often are paid fee-for-service (FFS) or capitation.  Physicians receiving FFS reimbursement receive additional compensation for each additional service they do.  For instance, physicians under FFS receive twice as much compensation for 2 office visits as they would for 1 office visit.  On the other hand,…

How to pay doctors: As a Merchant or a Guardian?

The book Systems of Survival (review) describes two moral structures: commerce and guardianship.  Jane Jacobs describes the ethics of Commerce as a moral syndrome equal, antagonistic, and complementary to the ethics of politics, or Guardianship.  Commerce provides the economic engine and the ethical framework for trade, technological advance, and individual rights that combine to make governments…

Physician Reimbursement and Technology adoption

Economists and health researchers have generally shown that when doctors are paid on a fee-for-service basis, they will advice the patient to undergo more medical procedures than when the doctor is paid on a capitation or salaried basis (see my own paper: “Operating on Commission“). Which payment method maximizes welfare has not been proven and…