Physician quality and payment schemes: A theoretical and empirical analysis

Calub, Renz Adrian (2014): Physician quality and payment schemes: A theoretical and empirical analysis. Published in: DLSU Business & Economics Review , Vol. 28, No. 1 (July 2018): pp. 110-127.

Abstract

Physicians are expected to provide the best health care to their patients; however, it cannot be discounted that their practice is driven primarily by incentives. In this paper, we construct a physician utility maximization model that links physician quality to compensation schemes. Results show that relative to fixed payment, fee-for-service and mixed payment yield higher quality. Multinomial treatment effects regression of vignette scores on payment schemes also support this hypothesis, indicating that physicians are still below the best level of quality and that incentives to improve are still present.

• Item Type: MPRA Paper
• Language: English
• Keywords: Physician, quality of healthcare, incentives, compensation schemes
• Subjects: I - Health, Education, and Welfare > I1 - Health > I11 - Analysis of Health Care Markets; J - Labor and Demographic Economics > J4 - Particular Labor Markets > J44 - Professional Labor Markets ; Occupational Licensing

References

Arrow KJ [1963]. “Uncertainty and the Welfare Economics of Medical Care”. The American Economic Review 53(5): 941-973. Retrieved 28 July 2011 from http://www.jstor.org/stable/1812044 .

Barnum H, Kutzin J, and Saxenian H [1995]. “Incentives and Provider Payment Methods”. The International Journal of Health Planning and Management 10(1): 23-45. Retrieved 27 May 2011. doi: 10.1002/hpm.4740100104

Brennan N and Shepard M [2010]. “Comparing Quality of Care in the Medicare Program”. American Journal of Managed Care 2010 16(11): 841-848. Retrieved 3 Jan 2013 from: http://www.ajmc.com/publications/issue/2010/2010-11-vol16-n11/ajmc_10nov_brennan841to848/4

Deb P and Trivedi PK [2006]. “Maximum simulated likelihood estimation of a negative binomial regression model with multinomial endogenous treatment”. The Stata Journal 6, Number 2: 246-255. Retrieved 14 Dec 2013 from: http://www.stata-journal.com/sjpdf.html?articlenum=st0105.

Deb P and Seck P [2009]. “Internal Migration, Selection Bias, and Human Development: Evidence from Indonesia and Mexico”, UNDP Human Development Research Paper 2009/31. Retrieved 14 Dec 2013 from: http://mpra.ub.uni-muenchen.de/19214/1/MPRA_paper_19214.pdf.

Demange G and Geoffard PY [2006]. “Reforming Incentive Schemes under Political Constraints: The Physician Agency”. Annals of Economics and Statistics / Annales d’Economie et de Statistique 83: 221-250. Retrieved 31 Jan 2012 from http://www.jstor.org/stable/20079169.

Devlin RA and Sarma S [2008]. “Do Physician Remuneration Schemes Matter? The Case of Canadian Family Physicians”. Journal of Health Economics 27(5): 1168-1181. Retrieved 4 Aug 2013 from: http://artsandscience.usask.ca/economics/research/pdf/SSarmaRemuneration Paper2.pdf.

Dresselhaus TR, Peabody JW, Lee M, Glassman P, Luck J [2000]. “Measuring Compliance with Preventive Care Guidelines: A Comparison of Standardized Patients, Clinical Vignettes and the Medical Record.” Journal of General Internal Medicine. Vol. 15 (11): 782-88.

Dresselhaus TR, Peabody JW, Luck J, and Bertenthal D [2004]. “An Evaluation of Vignettes for Predicting Variation in the Quality of Preventive Care.” Journal of General Internal Medicine. Vol. 19; 1013-1018.

Ellis RP and McGuire TG [1986]. “Provider Behavior under Prospective Reimbursement: Cost Sharing and Supply”. Journal of Health Economics 5: 129-151. Accessed 12 Dec 2011 from http://www.ppge.ufrgs.br/giacomo/arquivos/eco02072/ellis-mcguire-1986.pdf

Fortin B, Jacquemet N, and Shearer B [2010]. “Labour Supply, Work Effort and Contract Choice: Theory and Evidence on Physicians”. CIRANO Working Papers 2010s-40. CIRANO. Retrieved 31 Jan 2012 from http://www.cirpee.org/fileadmin/ documents/Cahiers_2010/CIRPEE10-34.pdf

Henning-Schmidt H, Selten R, and Wiesen D [2009]. “How Payment Systems Affect Physician’s Provision Behavior – An Experimental Investigation”. Discussion Paper 29/2009. Bonn Graduate School of Economics, University of Bonn. Retrieved 24 May 2012 from http://www.wiwi.uni-bonn.de/bgsepapers/bonedp/bgse03_2011.pdf

Kim C, Steers WN, Herman W, Mangione C, Venkat Narayan KM, and Ettner S [2007]. “Physician Compensation from Salary and Quality of Diabetes Care”. Society of General Internal Medicine 22: 448-452. Retrieved 15 Oct 2012. doi: 10.1007/s11606-007-0124-5.

Leonard KL, Masatu MC, and Vialou A [2007]. “Getting Doctors to Do Their Best: The Roles of Ability and Motivation in Health Care Quality”. The Journal of Human Resources 42(3): 682-700. Retrieved 26 May 2011 from: http://www.jstor.org/stable/40057323.

Libby A and Thurston NK [2001]. “Effects of Managed Care Contracting on Physician Labor Supply”. International Journal of Health Care Finance and Economics 1(2): 139-157. Retrieved 13 Oct 2011 from http://www.jstor.org/stable/3528869.

Luck J, Peabody JW, Dresselhaus TR, Lee M, and Glassman PA [2000]. “How Well Does Chart Abstraction Measure Quality? A Prospective Comparison of Standardized Patients with the Medical Record.” The American Journal of Medicine, Vol.108: 642-649.

Maddala G [1983]. “Models with self-selectivity”. Limited-Dependent and Qualitative Variables in Economics. New York: Cambridge University Press. Retrieved 12 April 2013 from: http://public.econ.duke.edu/~vjh3/e262p_07S/readings/Maddala_Models_of_Self-Selectivity.pdf

Peabody JW, Luck J, Glassman PA, Dresselhaus TR, Lee M. [2000] “Comparison of Vignettes, Standardized Patients, and Chart Abstraction: A Prospective Validation Study of 3 Methods for Measuring Quality.” Journal of the American Medical Association, 283(13): 1715-1722.

Peabody JW, Tozija F, Munoz JA, Nordyke RJ and Luck J. [2004] “Using Vignettes to Compare the Quality of Care Variation in Economically Divergent Countries.” Journal of Health Services Research. Vol. 39 (6): 03-0209r2. Retrieved from www.ncbi.nlm.nih.gov/pmc/articles/PM1361107/?tool=pubmed

Peabody JW, Luck J, Glassman P, Jain S, Spell M and Hansen J. [2004] “Measuring the Quality of Physician Practice by using Clinical Vignettes: a Prospective Validation Study.” Annals of Internal Medicine. Vol. 141(10): 771-80.

Peabody JW and Liu A. [2007]. “Comparing Quality in Disparate Settings Using Vignettes.” Journal of Health Policy and Planning. Vol 22(5): 294-302.

Peabody JW, Florentino J, Shimkhada R, Solon O, Quimbo S. [2010]. “Quality Variation and its Impact on Costs and Satisfaction: Evidence from the QIDS study,” Medical Care. 48 (1): 25-30

Peabody JW, Shimkhada R, Quimbo S, Florentino J, Bacate MF, McCulloch C, Solon O. [2011]. “Financial Incentives and Measurement Improved Physicians Quality of Care in the Philippines.” Health Affairs. 10 (4) 773-81

Peabody JW, Shimkhada R, Quimbo S, Solon O, Javier X, McCulloch C. [2013]. “The Impact of Performance Incentives on Child Health Outcomes: Results from a Cluster Randomized Controlled Trial in the Philippines.” Health Policy and Planning.

Phelps, CE [1992]. Health Economics. New York: Harper.

Quimbo S, Peabody JW, Shimkhada R, Woo K, Solon O [2008]. “Should we have confidence if a physician is accredited? A study of the relative impacts of accreditation and insurance payments on quality of care in the Philippines”. Social Science & Medicine 67: 505-510.

Quimbo S, Peabody JW, Javier X, Shimkhada R, Solon O [2011]. “Pushing on a string: How policy might encourage private doctors to compete with the public sector on the basis of quality”. Economics Letters 110, 101-103.

Rice T [1997]. “Physician Payment Policies: Impacts and Implications”. Annual Review of Public Health 18, 549-65.

Shane D and Trivedi P [2012]. “What Drives Differences in Health Care Demand? The Role of Health Insurance and Selection Bias”. Health, Econometrics and Data Group (HEDG) Working Papers, 12(09). Retrieved 14 Dec 2013 from http://www.york.ac.uk/media/economics/documents/herc/wp/12_09.pdf.

Shimkhada R, Peabody JW, Quimbo S, Solon O. [2008]. “The Quality Improvement Demonstration Study: An Example of Evidence-Based Policy-Making in Practice.” Health Research Policy and Systems. 25;6: 5.

Solon O, Woo K, Quimbo SA, Peabody JW, Florentino J, Shimkhada R. [2009]. “A Novel Method for Measuring Health Care System Performance: Experience from QIDS in the Philippines,” Health Policy and Planning. 24(3):167-74

Thorton J and Eakin BK [1997]. “The Utility-Maximizing Self-Employed Physician”. The Journal of Human Resources 32 (1), 98-128. Retrieved 27 May 2011. doi: 10.2307/146242.

UPecon—Health Policy Development Program [2007]. Operational Plan Baseline Survey [Dataset].

UPecon—Health Policy Development Program [2011]. Documentation of the HPDP Data Library. Unpublished manuscript.

World Health Organization [2011]. Noncommunicable Diseases Country Profile 2011. Retrieved 24 Jan 2013 from: http://whqlibdoc.who.int/publications/2011/9789241502283_eng.pdf?ua=1

World Health Organization and Department of Health Philippines [2012]. Philippines Health Service Delivery Profile 2012. Retrieved from: http://www.wpro.who.int/health_services/service_delivery_profile_philippines.pdf.

Zweifel P and Breyer F [1997]. Health Economics. New York: Oxford University Press.