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Money matters – primary care providers' perceptions of payment incentives

Money matters – primary care providers' perceptions of payment incentives 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.Design/methodology/approachAn 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.FindingsFindings 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.Practical implicationsPolicymakers 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.Originality/valueThis study contributes evidence on unit-level payment incentives in primary care, a scarcely researched topic, especially using qualitative methods. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Health Organisation and Management Emerald Publishing

Money matters – primary care providers' perceptions of payment incentives

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Publisher
Emerald Publishing
Copyright
© Emerald Publishing Limited
ISSN
1477-7266
DOI
10.1108/jhom-06-2020-0225
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Abstract

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.Design/methodology/approachAn 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.FindingsFindings 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.Practical implicationsPolicymakers 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.Originality/valueThis study contributes evidence on unit-level payment incentives in primary care, a scarcely researched topic, especially using qualitative methods.

Journal

Journal of Health Organisation and Management – Emerald Publishing

Published: Jun 8, 2021

Keywords: Primary care; Sweden; GPs; Incentives; Payments; Interview study

References

  • The impact of multi-professional group practices. Evaluation aims and methods for ‘Maisons’, ‘Pôles de Santé’ and ‘centres de Santé’ within the framework of experiments with new mechanisms of remuneration
    Afrite, A.; Bourgueil, Y.; Daniel, F.; Mousquès, J.
  • Equity impact of a choice reform and change in reimbursement system in primary care in Stockholm county council
    Agerholm, J.; Bruce, D.; de Leon, A.P.; Burström, B.
  • Choice and Privatisation in Swedish primary care
    Anell, A.
  • Sweden. Health system review
    Anell, A.; Glenngård, A.H.; Merkur, S.
  • Does risk-adjusted payment influence primary care providers' decision on where to set up practices?
    Anell, A.; Dackehag, M.; Dietrichson, J.
  • What's measured is what matters: targets and gaming in the English public health care system
    Bevan, G.; Hood, C.
  • What determines the behaviour and performance of health professionals? Public service motivation, professional norms and/or economic incentives
    Bøgh Andersen, L.
  • Is the co-location of GPs in primary care centres associated with a higher patient satisfaction? Evidence from a population survey in Italy
    Bonciani, M.; Barsanti, S.; Murante, A.M.
  • Medical group practice in primary care in six European countries, and the Canadian provinces of Ontario and Quebec: what are the lessons for France
    Bourgueil, Y.; Marek, A.; Mousquès, J.
  • Equity aspects of the primary health care choice reform in Sweden – a scoping review
    Burström, B.; Burström, K.; Nilsson, G.; Tomson, G.; Whitehead, M.; Winblad, U.
  • Effects of financial incentives on medical practice: results from a systematic review of the literature and methodological issues
    Chaix-Couturier, C.; Durand-Zaleski, I.; Jolly, D.; Durieux, P.
  • Self-determination theory in work organizations: the state of a science
    Deci, E.L.; Olafsen, A.H.; Ryan, R.M.
  • Key issues in the design of pay for performance programs
    Eijkenaar, F.
  • Can pay-for-performance to primary care providers stimulate appropriate use of antibiotics?
    Ellegård, L.M.; Dietrichson, J.; Anell, A.
  • Creaming, skimping and dumping: provider competition on the intensive and extensive margins
    Ellis, R.P.
  • Five misunderstandings about case-study research
    Flyvbjerg, B.
  • When financial incentives do more good than harm: a checklist
    Glasziou, P.P.; Buchan, H.; Del Mar, C.; Doust, J.; Harris, M.; Knight, R.; Scott, A.; Scott, I.A.; Stockwell, A.
  • Pursuing the objectives of support to providers and external accountability through enabling controls - a study of governance models in Swedish primary care
    Glenngård, A.H.
  • Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians
    Gosden, T.; Forland, F.; Kristiansen, I.S.; Sutton, M.; Leese, M.; Giuffrida, A.; Sergison, M.; Pedersen, L.
  • Code saturation versus meaning saturation: how many interviews are enough?
    Hennink, M.M.; Kaiser, B.N.; Marconi, V.C.
  • Free establishment of primary health care providers: effects on geographical equity
    Isaksson, D.; Blomqvist, P.; Winblad, U.
  • A typology for provider payment systems in health care
    Jegers, M.; Kesteloot, K.; De Graeve, D.; Gilles, W.
  • Should all GPs become NHS employees?
    Majeed, A.; Buckman, L.
  • Primary healthcare in transition – a qualitative study of how managers perceived a system change
    Maun, A.; Nilsson, K.; Furåker, C.; Thorn, J.
  • General practice workforce. September 2019
  • Short-term effects of a pay-for-performance Programme for diabetes in a primary care setting: an observational study
    Ödesjö, H.; Anell, A.; Gudbjörnsdottir, S.; Thorn, J.; Björck, S.
  • Theory and practice in the design of physician payment incentives
    Robinson, J.C.
  • The Netherlands: Health system review
    Schäfer, W.; Kroneman, M.; Boerma, W.; van den Berg, M.; Westert, G.; Devillé, W.; van Ginneken, E.
  • The effect of financial incentives on the quality of health care provided by primary care physicians
    Scott, A.; Sivey, P.; Ouakrim, A.D.; Willenberg, L.; Naccarella, L.; Furler, J.; Young, D.
  • The risk of upcoding in casemix systems: a comparative study
    Steinbusch, P.J.M.; Oostenbrink, J.B.; Zuurbier, J.J.; Schaepkens, F.J.M.
  • The impact of reimbursement systems on equity in access and quality of primary care: a systematic literature review
    Tao, W.; Agerholm, J.; Burström, B.
  • Patient choice and provider competition – quality enhancing drivers in primary care?
    Vengberg, S.; Fredriksson, M.; Winblad, U.