title: The effect of capitated and fee-for-service remuneration on physician decision making in gynecology.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Hutzel Hospital/Wayne State University School of Medicine, Detroit, Michigan, USA.
authors.forename: S B
authors.initials: SB
authors.lastname: Ransom
authors.forename: S G
authors.initials: SG
authors.lastname: McNeeley
authors.forename: M L
authors.initials: ML
authors.lastname: Kruger
authors.forename: G
authors.initials: G
authors.lastname: Doot
authors.forename: D B
authors.initials: DB
authors.lastname: Cotton
mesh_terms: 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