Ransom S B, McNeeley S G, Kruger M L, Doot G, Cotton D B
Department of Obstetrics and Gynecology, Hutzel Hospital/Wayne State University School of Medicine, Detroit, Michigan, USA.
Obstet Gynecol. 1996 May;87(5 Pt 1):707-10. doi: 10.1016/0029-7844(96)00008-7.
To evaluate the variations in physician behavior leading to performance of gynecologic surgical procedures related to fee-for-service and capitation reimbursement systems.
This study compared the physician practice utilization of surgical services for fee-for-service and capitated contract reimbursement systems within a gynecology clinic. Attending gynecologists were reimbursed on a fee-for-service basis for all surgical services performed during a 6-month interval; subsequently, the same physicians were reimbursed on a capitated basis for 6 months and received a fixed payment for the clinical and surgical services provided.
Three thousand seven hundred eighty consecutive outpatient gynecology visits were evaluated at the university gynecology clinic during 1994. We found a 15% overall decrease in the number of surgical procedures that were performed during the capitated reimbursement period compared with the fee-for-service time interval. The procedure most responsible for the reduction of surgical services was elective sterilization by laparoscopy, which underwent a statistically significant decrease (P < .01).
The remuneration system in our review seemed to affect physician decision making for only the most elective procedures, whereas physicians maintained similar practice patterns for more severe conditions. Fee-for-service seems to encourage, whereas capitation seems to discourage, gynecologist from performing elective procedures.
评估与按服务收费和按人头付费报销系统相关的妇科手术操作中医师行为的变化。
本研究比较了妇科诊所内按服务收费和按人头付费合同报销系统下手术服务的医师实践利用情况。主治妇科医生在6个月期间内进行的所有手术服务均按服务收费；随后，同一批医生在接下来的6个月内按人头付费，并为所提供的临床和手术服务获得固定报酬。
1994年在大学妇科诊所对连续3780次门诊妇科就诊进行了评估。我们发现，与按服务收费时间段相比，按人头付费报销期间进行的手术操作数量总体下降了15%。导致手术服务减少的最主要操作是腹腔镜选择性绝育术，其下降具有统计学意义（P <.01）。
我们综述中的薪酬系统似乎仅影响医生对最具选择性的手术操作的决策，而对于病情较重的情况，医生保持相似的实践模式。按服务收费似乎会鼓励妇科医生进行选择性手术，而按人头付费则似乎会起到抑制作用。
