Access the full text.
Sign up today, get DeepDyve free for 14 days.
Sofie Vengberg, M. Fredriksson, U. Winblad (2019)
Patient choice and provider competition - Quality enhancing drivers in primary care?Social science & medicine, 226
M. Hennink, B. Kaiser, V. Marconi (2017)
Code Saturation Versus Meaning SaturationQualitative Health Research, 27
J. Agerholm, D. Bruce, A. Leon, B. Burström (2015)
Equity impact of a choice reform and change in reimbursement system in primary care in Stockholm County CouncilBMC Health Services Research, 15
A. Anell, Margareta Dackehag, J. Dietrichson (2018)
Does risk-adjusted payment influence primary care providers’ decision on where to set up practices?BMC Health Services Research, 18
F. Eijkenaar (2011)
Key issues in the design of pay for performance programsThe European Journal of Health Economics, 14
(2019)
General practice workforce. September 2019
Y. Bourgueil, Anna Marek, J. Mousquès (2009)
[Medical group practice in primary care in six European countries, and the Canadian provinces of Ontario and Quebec: what are the lessons for France ?].Sante publique, 21 Spec No 1
G. Bevan, C. Hood (2006)
What's measured is what matters: targets and gaming in the English public health care systemPublic Administration, 84
James Robinson (2001)
Theory and practice in the design of physician payment incentives.The Milbank quarterly, 79 2
T. Gosden, F. Forland, I. Kristiansen, M. Sutton, B. Leese, A. Giuffrida, M. Sergison, L. Pedersen (2000)
Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians.The Cochrane database of systematic reviews, 3
D. Isaksson, P. Blomqvist, U. Winblad (2015)
Free establishment of primary health care providers: effects on geographical equityBMC Health Services Research, 16
P. Glasziou, H. Buchan, C. Mar, J. Doust, M. Harris, Rosemary Knight, A. Scott, I. Scott, Alexis Stockwell (2012)
When financial incentives do more good than harm: a checklistBMJ : British Medical Journal, 345
Questions d’économie de La Santé, 189
W. Schäfer, M. Kroneman, W. Boerma, M. Berg, G. Westert, W. Devillé, E. Ginneken (2016)
The Netherlands: health system review.Health systems in transition, 12 1
M. Bonciani, S. Barsanti, A. Murante (2017)
Is the co-location of GPs in primary care centres associated with a higher patient satisfaction? Evidence from a population survey in ItalyBMC Health Services Research, 17
Andy Maun, K. Nilsson, C. Furåker, J. Thorn (2013)
Primary healthcare in transition – a qualitative study of how managers perceived a system changeBMC Health Services Research, 13
R. Ellis (1998)
Creaming, skimping and dumping: provider competition on the intensive and extensive margins.Journal of health economics, 17 5
A. Majeed, L. Buckman (2016)
Should all GPs become NHS employees?British Medical Journal, 355
L. Andersen (2009)
What determines the behaviour and performance of health professionals? Public service motivation, professional norms and/or economic incentivesInternational Review of Administrative Sciences, 75
A. Glenngård (2019)
Pursuing the objectives of support to providers and external accountability through enabling controls - a study of governance models in Swedish primary careBMC Health Services Research, 19
L. Ellegård, J. Dietrichson, A. Anell (2017)
Can pay‐for‐performance to primary care providers stimulate appropriate use of antibiotics?Health Economics, 27
B. Burström, K. Burström, G. Nilsson, G. Tomson, M. Whitehead, U. Winblad (2017)
Equity aspects of the Primary Health Care Choice Reform in Sweden – a scoping reviewInternational Journal for Equity in Health, 16
E. Deci, A. Olafsen, R. Ryan (2017)
Self-Determination Theory in Work Organizations: The State of a Science, 4
H. Ödesjö, A. Anell, S. Gudbjörnsdottir, J. Thorn, S. Björck (2015)
Short-term effects of a pay-for-performance programme for diabetes in a primary care setting: an observational studyScandinavian Journal of Primary Health Care, 33
Questions d’économie de La Santé, 127
A. Anell, A. Glenngård, S. Merkur (2012)
Sweden health system review.Health systems in transition, 14 5
A. Scott, Peter Sivey, D. Ouakrim, L. Willenberg, L. Naccarella, J. Furler, D. Young (2011)
The effect of financial incentives on the quality of health care provided by primary care physicians.The Cochrane database of systematic reviews, 9
Paul Steinbusch, J. Oostenbrink, J. Zuurbier, Frans Schaepkens (2007)
The risk of upcoding in casemix systems: a comparative study.Health policy, 81 2-3
A. Anell (2010)
Choice and privatisation in Swedish primary careHealth Economics, Policy and Law, 6
W. Tao, J. Agerholm, B. Burström (2016)
The impact of reimbursement systems on equity in access and quality of primary care: A systematic literature reviewBMC Health Services Research, 16
M. Jegers, K. Kesteloot, D. Graeve, Willem Gilles (2002)
A typology for provider payment systems in health care.Health policy, 60 3
C. Chaix-couturier, I. Durand-zaleski, D. Jolly, P. Durieux (2000)
Effects of financial incentives on medical practice: results from a systematic review of the literature and methodological issues.International journal for quality in health care : journal of the International Society for Quality in Health Care, 12 2
B. Flyvbjerg (2006)
Five Misunderstandings About Case-Study ResearchQualitative Inquiry, 12
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 of Health Organisation and Management – Emerald Publishing
Published: Jun 8, 2021
Keywords: Primary care; Sweden; GPs; Incentives; Payments; Interview study
Read and print from thousands of top scholarly journals.
Already have an account? Log in
Bookmark this article. You can see your Bookmarks on your DeepDyve Library.
To save an article, log in first, or sign up for a DeepDyve account if you don’t already have one.
Copy and paste the desired citation format or use the link below to download a file formatted for EndNote
Access the full text.
Sign up today, get DeepDyve free for 14 days.
All DeepDyve websites use cookies to improve your online experience. They were placed on your computer when you launched this website. You can change your cookie settings through your browser.