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Healthcare Quality by Specialists Under a Mixed Compensation System: An Empirical Analysis
Damien Echevin1, Bernard Fortin2, Aristide Houndetoungan3
1CRCHUS, and Université de Sherbrooke, Sherbrooke, Québec, Canada.
Health Economics
|March 3, 2025
Summary
A 1999 Quebec reform introducing mixed compensation (MC) for specialists reduced healthcare quality. This payment model, combining per diem and reduced service fees, increased risks of rehospitalization and mortality post-discharge.
Area of Science:
- Health Economics
- Healthcare Policy
- Medical Quality Assessment
Background:
- Physician compensation models significantly influence healthcare delivery and quality.
- Understanding the impact of mixed compensation (MC) schemes is crucial for healthcare policy.
- A 1999 reform in Quebec, Canada, introduced a novel MC payment system for specialists.
Purpose of the Study:
- To evaluate the impact of Quebec's 1999 mixed compensation (MC) reform on the quality of specialist healthcare services.
- To quantify changes in patient outcomes, specifically rehospitalization and mortality risks, following the reform.
Main Methods:
- Utilized a large patient/physician panel dataset for comprehensive analysis.
- Employed a multi-state multi-spell hazard model, akin to a difference-in-differences approach.
- Derived quality indicators directly from the estimated model parameters.
Main Results:
- The mixed compensation (MC) scheme reform was associated with a reduction in healthcare quality.
- Analysis indicated an increased risk of rehospitalization after discharge for patients receiving MC specialist services.
- A higher risk of mortality following discharge was also observed, linked to the MC reform.
Conclusions:
- The mixed compensation (MC) payment model implemented in Quebec led to decreased quality of specialist care.
- Healthcare policy reforms require careful consideration of potential adverse effects on patient outcomes.
- Further research into optimal physician payment structures is warranted to ensure high-quality healthcare.
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