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Capitation and its effects on physician satisfaction.

P H Tyrance1, S Sims, N Ma'luf

  • 1Harvard Medical School and Kennedy School of Government, Harvard University, Boston, MA, USA.

Cost & Quality Quarterly Journal : CQ
|June 3, 1999
PubMed
Summary

Physicians transitioning to capitation payment models report significantly lower satisfaction, particularly regarding patient care autonomy. Addressing physician concerns through education and improved management relations is crucial for a smoother transition.

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Area of Science:

  • Health Services Research
  • Medical Economics
  • Physician Workforce Studies

Background:

  • Capitation payment is increasingly prevalent in healthcare reimbursement.
  • Limited data exists on the impact of capitation on physician satisfaction.
  • Academic medical centers are adopting capitation models, necessitating an understanding of physician perspectives.

Purpose of the Study:

  • To examine the perceived effects of capitation on physician satisfaction.
  • To compare physician satisfaction under fee-for-service versus capitation models.
  • To identify factors influencing physician satisfaction in a capitated environment.

Main Methods:

  • A survey was conducted among physicians at a large, urban, tertiary care teaching hospital.
  • A 5-point Likert scale assessed satisfaction with current practice and expected satisfaction under capitation.

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  • Logistic regression analysis identified predictors of overall physician satisfaction.

    • Main Results:

    • A 62% response rate (363/587) was achieved among physicians with direct patient care responsibilities.
    • Physicians reported significantly lower satisfaction with caring for capitated patients compared to fee-for-service.
    • Key factors influencing overall satisfaction included patient load, resource utilization efficiency, employment stability, and schedule control.

    Conclusions:

    • Physicians initially exposed to capitation exhibit strong negative perceptions, even in areas where benefits are anticipated.
    • Physician education and enhanced management relations are recommended to facilitate the transition to capitated reimbursement.
    • Addressing physician concerns is vital for successful implementation of capitation models.