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Does a year make a difference? Changes in physician satisfaction and perception in an increasingly capitated
E S Nadler1, S Sims, P H Tyrance
1Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
The American Journal of Medicine
|July 14, 1999
Summary
Physician satisfaction with capitation improved after one year, but concerns about this payment model persisted. Experience with capitation did not fully alleviate physician apprehension regarding its differences from fee-for-service.
Area of Science:
- Health Services Research
- Medical Economics
- Physician Payment Models
Background:
- Capitation is a growing healthcare payment model.
- Limited data exists on physician satisfaction with increasing experience in capitation.
Purpose of the Study:
- To assess changes in physician satisfaction with capitation over time.
- To compare physician satisfaction between capitated and fee-for-service models.
- To evaluate ethical concerns associated with capitation.
Main Methods:
- Surveyed physicians in an urban teaching hospital's physician-hospital organization in 1996 and 1997.
- Assessed changes in practice satisfaction, comparing fee-for-service and capitation.
- Monitored the increase in capitated contract coverage from <5% to nearly 25% for patients under 65.
Main Results:
- Overall physician satisfaction increased from 57% in 1996 to 71% in 1997.
- Physicians reporting increased satisfaction with patient load, discussion time, and care coordination.
- Despite improvements, physicians remained significantly more satisfied with fee-for-service than capitation in both years.
Conclusions:
- Initial physician perceptions of capitation were negative.
- Physician satisfaction with capitation improved with experience, but dissatisfaction compared to fee-for-service widened.
- Physician concerns regarding capitation may not be resolved solely through experience.