Market incentives, plan choice, and price increases. (1/399)

The Federal Employees Health Benefits Program (FEHBP) has attracted considerable interest for its ability to control health care costs. We examine the impact of the FEHBP's maximum dollar contribution on incentives to select low-cost plans and the growth in insurance premiums over time. Unless the maximum dollar contribution is pegged to a low-price plan, few enrollees select such plans. Moreover, premiums rise at least five percentage points per year faster among plans below this fixed subsidy level than they do in plans above it. Our results have important implications for the design of similar market-based approaches.  (+info)

Effects of financial incentives on medical practice: results from a systematic review of the literature and methodological issues. (2/399)

OBJECTIVE: To identify all financial incentives that had been proposed, described, or used regardless of their initial objective and, when possible, to assess the results of these incentives on costs, process or outcomes of care. MATERIAL AND METHODS: Systematic review of the literature. Databases searched were: Medline, Embase, Health Planning and Administration, Pascal, International Pharmaceutical Abstracts and the Cochrane Library. Search terms were: health professionals and tape of practice, type of incentive, methodology, languages English or French, January 1993 to May 1999. RESULTS: Financial incentives concerned the modalities of physician payment and financing of the health care system. Confounding factors included: age of the doctor, training, speciality, place and type of medical practice, previous sanctions for over-prescribing, type and severity of disease, type of insurance. Risks of financial incentives were: limited access to certain types of care, lack of continuity of care, conflict of interests between the physician and the patient. Any form of fund-holding or capitation decreased the total volume of prescriptions by 0-24%, and hospital days by up to 80% compared with fee-for-service. Annual cap on doctors' incomes resulted in referrals to colleagues when target income is reached. DISCUSSION: Financial incentives can be used to reduce the use of health care resources, improve compliance with practice guidelines or achieve a general health target. It may be effective to use incentives in combination depending on the target set for a given health care programme.  (+info)

Need for an incentive-based reimbursement policy toward quality care for dialysis patient management. (3/399)

BACKGROUND: In view of the growing dialysis population and the increasing reimbursement cost in the industrialized countries, a critical evaluation of the dialysis economy is warranted. METHODS: Data for the reimbursement and dialysis patients' statistics were collected from the National Medical Care Expenditure (NMCE), 1979-1996, which was published by the Japanese government, and the article "An overview of regular dialysis treatment in Japan," 1979-1998, by the Japanese Society for Dialysis Therapy, as well as unpublished data from the Yokohama Dai-ichi Hospital and 10 affiliated urban dialysis centers. RESULTS: From 1979 to 1996, the dialysis population increased 5.2 times and the NMCE increased 2.5 times, whereas the end-stage renal disease (ESRD) payment increased only 1.8 times. Because of a drastic reduction in the dialyzer cost and the dialysis-related technical fee, both the percentage of ESRD-related payment within NMCE and ESRD payment per capita per year decreased from 5.4 to 4.1% and from 16.3 million yen to 5.6 million yen, respectively. Despite this drastic cost reduction, the patient survival and quality of life determined by the social rehabilitation rate did not decline. CONCLUSION: The Japanese health insurance policy for dialysis management achieved a successful cost cut during the 1979-1996 period by using an incentive-based payment system toward quality care. However, the forthcoming further exponential increase in the dialysis population may put the dialysis economy and hence dialysis care quality in jeopardy. Effort must be made to reduce the ESRD-related cost through prevention of the progression of kidney diseases, propagation of renal transplantation, and internationalization of continuous ambulatory peritoneal dialysis and erythropoietin cost. A reduction in dialysis reimbursement, if necessary, must be achieved through an incentive-based system toward quality patient care.  (+info)

How does risk sharing between employers and a managed behavioral health organization affect mental health care? (4/399)

OBJECTIVE: To study the ways in which allocating the risk for behavioral health care expenses between employers and a managed behavioral health organization affects costs and the use of services. DATA SOURCES: Claims from 87 plans that cover mental health and substance abuse services covering over one million member years in 1996/1997. STUDY DESIGN: Multi-part regression models for health care cost are used. Dependent variables are health care costs decomposed into access to any care, costs per user, any inpatient use, costs per outpatient user, and costs per inpatient user. The study compares full-risk plans, in which the managed care organization provides managed care services and acts as the insurer by assuming the risk for claims costs, with contracts in which the managed care organization only manages care (for a fixed administrative fee) and the employer retains the risk for claims. PRINCIPAL FINDINGS: Full-risk plans are not statistically significantly different from non-risk plans in terms of any mental health specialty use or hospitalization rates, but costs per user are significantly lower, in particular for inpatients. CONCLUSIONS: Risk contracts do not affect initial access to mental health specialty care or hospitalization rates, but patients in risk contracts have lower costs, either because of lower intensity of care or because they are treated by less expensive providers.  (+info)

Tracking managed care: the importance of a cash incentive for medical director response to a survey. (5/399)

OBJECTIVE: To assess the impact of a monetary incentive in a survey mailed to medical directors of large medical groups and independent practice associations (IPAs). STUDY DESIGN: Mailed survey. METHODS: We mailed a survey to the medical directors of all medical groups and IPAs contracted with Blue Cross California Care, a large California managed care health plan (n = 174). After 2 mailings without any monetary incentive, we included a $50 bill in the third mailing to increase the response rate. RESULTS: Only 46 medical directors responded to the first and second mailings (response rates of 17% and 13%, respectively). The third mailing, which included a $50 bill attached to the front of the survey, yielded 78 responses (66%), for an overall total of 124 (76%). We found no significant differences in the physician organizations of medical directors who responded to the mailing with the $50 incentive compared with the physician organizations of those who responded to 1 of the first 2 mailings, although medical directors who responded without the financial incentive were more likely to report that their organization had staff for quality assurance (96% vs 82%; P < or = .03). CONCLUSION: Including a $50 bill improved the rate of response to a survey mailed to medical directors from 13%-17% to 66%.  (+info)

The use of monetary incentives in a community survey: impact on response rates, data quality, and cost. (6/399)

OBJECTIVES: To assess the effect of incentive size on response rates, data quality, and cost in a digestive health status mail survey of a community sample of health plan enrollees. DATA SOURCES/SETTING: The study population was selected from a database of enrollees in various health plans obligated to receive care at Park Nicollet Clinic-HealthSystem Minnesota, a large, multispecialty group in Minneapolis, Minnesota, and the nearby suburbs. STUDY DESIGN: A total of 1,800 HealthSystem Minnesota enrollees were randomly assigned to receive a survey with an incentive of $5 or $2. The response rates for each incentive level were determined. Data quality, as indicated by item nonresponse and scale scores, was measured. Total cost and cost per completed survey were calculated. PRINCIPAL FINDINGS: The response rate among enrollees receiving $5 (74.3 percent) was significantly higher than among those receiving $2 (67.4 percent); differences were more pronounced in the first wave of data collection. Data quality did not differ between the two incentive groups. The total cost per completed survey was higher in the $5 condition than in the $2 condition. CONCLUSIONS: A $5 incentive resulted in a higher response rate among a community patient sample with one mailing than did a $2 incentive. However, the response rates in the $2 condition approached the level of the $5 incentive, and costs were significantly lower when the full follow-up protocol was completed. Response rates were marginally increased by follow-up phone calls. The incentive level did not influence data quality. The results suggest if a survey budget is limited and a timeline is not critical, a $2 incentive provides an affordable means of increasing participation.  (+info)

Shifting ethics: debating the incentive question in organ transplantation. (7/399)

The paper reviews the discussion within transplantation medicine about the organ supply and demand problem. The focus is on the evolution of attitudes toward compensation plans from the early 1980s to the present. A vehement rejection on ethical grounds of anything but uncompensated donation--once the professional norm--has slowly been replaced by an open debate of plans that offer financial rewards to persons willing to have their organs, or the organs of deceased kin, taken for transplantation. The paper asks how this shift has occurred and what it tells us about the dynamics of bioethical debates, both within professional circles and in wider public arenas.  (+info)

Effects of compensation method on physician behaviors. (8/399)

OBJECTIVE: To examine physician and leader perceptions of the relationship between physician compensation and the productivity of physicians practicing in medical groups. STUDY DESIGN: Key informant interviews identified subjects' perceptions of factors influencing physician productivity and the behavioral effects of individual financial incentives. Interview transcripts were analyzed by a team of physicians, economists, and other researchers. STUDY POPULATION: Physicians, medical leaders, and group practice administrators (n = 114) representing 46 medical group practices in California, Oregon, Washington, and Wisconsin were interviewed. RESULTS: Five major themes emerged: (1) Most physicians reported that financial incentives did not substantially affect their own behavior, except for productivity. However, they suggested that specific compensation models do lead to certain seemingly undesirable physician behaviors. (2) By contrast, medical group leaders reported that financial incentives do affect a variety of physician behaviors. (3) Four productivity drivers emerged: financial incentives, demand-side factors, systems and infrastructure, and other individual or group attributes. (4) Physician compensation systems are evolving toward a blend of production-based and production-neutral incentives, plus new metrics aligned with the demands of managed care. (5) Culture, size, and specialty mix are significant determinants of group physician compensation systems. CONCLUSIONS: Compensation method is perceived to be a significant influence on physician productivity, particularly among group practice leaders. The changing context of medical practice represents another powerful "macro" lever on physician behavior.  (+info)