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Patient Attitudes Toward Physician Financial Incentives
Anne G. Pereira, MD;
Steven D. Pearson, MD, MSc
Arch Intern Med. 2001;161:1313-1317.
Background Despite concern about the impact of financial incentives on physician
behavior, little is known about patients' attitudes toward these incentives.
Objectives To assess patient attitudes toward physician compensation models and
to explore patient characteristics associated with these attitudes.
Methods We mailed a survey to 2000 adult patients in a large New England health
maintenance organization. We asked about their trust in their primary care
physician; discomfort with compensation models of salary with withhold (salary),
fee-for-service with withhold, and group capitation (capitation).
Results One thousand one hundred twenty-five (56%) of the 2000 patients who
responded expressed varying levels of discomfort with the proposed compensation
models: 16% for salary, 25% for fee-for-service with withhold, and 53% for
capitation (P<.001). Patients who knew their primary care
physician was paid through capitation did not report less trust in their primary
care physician but still frequently expressed discomfort (46%) with capitation.
Among all respondents, those who were younger, white, had better health, had
a higher income, were more educated, and who lacked a very trusting relationship
with a primary care physician were more likely to report discomfort with both
capitation and fee-for-service with withhold. In multivariable analyses, discomfort
with capitation was more common among white patients (odds ratio, 2.6; 95%
confidence interval, 1.6-4.2), patients with incomes exceeding $20 000
(odds ratio, 3.7; 95% confidence interval, 2.3-6.1), and college-educated
patients (odds ratio, 2.0; 95% confidence interval, 1.4-2.7).
Conclusions Most patients were uncomfortable with 1 or more of the 3 common methods
used to pay physicians. Discomfort was highest with capitation and was more
likely among wealthier, well-educated, white patients. With capitation increasing
nationally, patients' concerns should be considered in the design of compensation
agreements.
From the Center for Ethics in Managed Care, and the Department of
Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass.
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