The effect of capitated and fee-for-service remuneration on physician decision making in gynecology.
OBJECTIVE
To evaluate the variations in physician behavior leading to performance of gynecologic surgical procedures related to fee-for-service and capitation reimbursement systems.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Ransom
S B
SB
Department of Obstetrics and Gynecology, Hutzel Hospital/Wayne State University School of Medicine, Detroit, Michigan, USA.
McNeeley
S G
SG
Kruger
M L
ML
Doot
G
G
Cotton
D B
DB
D000328:Adult; D002204:Capitation Fee; D003363:Cost Control; D017558:Elective Surgical Procedures / Q000191:economics* / Q000706:statistics & numerical data; D018588:Fee-for-Service Plans; D005260:Female; D005831:Genital Diseases, Female / Q000191:economics* / Q000601:surgery*; D006801:Humans; D010044:Outpatient Clinics, Hospital / Q000191:economics; D010818:Practice Patterns, Physicians' / Q000191:economics*; D012189:Retrospective Studies; D013245:Sterilization, Reproductive / Q000191:economics / Q000706:statistics & numerical data