Leider P J, Solberg R, Nesbitt T
Johns Hopkins Medical Center, Baltimore, USA.
Fam Med. 1997 May;29(5):318-20.
The influence of capitation versus fee-for-service reimbursement for services provided by primary care physicians is an important topic as capitation becomes increasingly prevalent. This study ascertained whether family physicians perceive an economic incentive to perform flexible sigmoidoscopy, colposcopy, and vasectomy under capitated versus fee-for-service payment structures.
In May 1995, questionnaires were mailed to 592 randomly selected physician "diplomates" of the American Board of Family Practice in California, Florida, Texas, Virginia, and Minnesota. Nonrespondents received an additional mailing in July 1995.
The return rate was 62%. Of 336 responses: 1) 177 (52%) provide flexible sigmoidoscopy; 68 (20%) think capitation and 173 (51%) think fee for service provide sufficient reimbursement to make this procedure profitable. 2) 69 (20%) provide colposcopy; 50 (16%) think capitation and 99 (30%) think fee for service provide sufficient reimbursement to make this procedure profitable. 3) 91 (27%) provide flexible sigmoidoscopy; 36 (11%) think capitation and 84 (25%) think fee for service provide sufficient reimbursement to make this procedure profitable.
A significant number of family physicians provide these three procedures in their offices. Most physicians view fee-for-service payment as providing an economic incentive to provide these procedures. Capitation was less frequently perceived as providing sufficient reimbursement to make the provision of these procedures profitable.
随着按人头付费方式越来越普遍，初级保健医生服务的按人头付费与按服务收费报销方式的影响成为一个重要话题。本研究确定了家庭医生在按人头付费与按服务收费的支付结构下，是否认为有经济激励去进行乙状结肠镜检查、阴道镜检查和输精管切除术。
1995年5月，向加利福尼亚州、佛罗里达州、得克萨斯州、弗吉尼亚州和明尼苏达州随机抽取的592名美国家庭医学委员会的医生“文凭持有者”邮寄问卷。未回复者在1995年7月又收到一次邮寄问卷。
回复率为62%。在336份回复中：1）177人（52%）进行乙状结肠镜检查；68人（20%）认为按人头付费，173人（51%）认为按服务收费能提供足够的报销以使该检查有利可图。2）69人（20%）进行阴道镜检查；50人（16%）认为按人头付费，99人（30%）认为按服务收费能提供足够的报销以使该检查有利可图。3）91人（27%）进行输精管切除术；36人（11%）认为按人头付费，84人（25%）认为按服务收费能提供足够的报销以使该手术有利可图。
相当数量的家庭医生在其办公室进行这三种手术。大多数医生认为按服务收费支付方式为进行这些手术提供了经济激励。按人头付费被认为能提供足够报销以使进行这些手术有利可图的情况较少见。
