title: Economic incentives and the distribution of extracorporeal shock wave lithotripters and linear accelerators in Spain.
abstract: We studied the role of economic incentives for private providers in explaining Spain's disproportionately large number of extracorporeal shock wave lithotripters (ESWLs) and low number of linear accelerators (linacs) per million population (pmp) in comparison to other countries of the Organization for Economic Cooperation and Development (OECD). We found that the reimbursement policy for 1990 allowed an average profit per private ESWL of $732,000, but no profit for linacs. Regional per-capita income was positively correlated with ESWLs pmp in Spain (R2 = 0.49; p = .001), but not with linacs. Sixty-nine percent of ESWLs were privately held versus only 16% of linacs. To avoid these types of distortions, financial incentives should be based on a reasonable relationship between cost and charges and should be associated with the appropriateness of medical care.
authors.affiliation: Instituto de Salud Carlos III.
authors.forename: P
authors.initials: P
authors.lastname: Lázaro
authors.forename: K
authors.initials: K
authors.lastname: Fitch
mesh_terms: D002201:Capital Expenditures / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis; D004059:Diffusion of Innovation; D005060:Europe; D005249:Fees and Charges / Q000706:statistics & numerical data*; D006801:Humans; D007349:Insurance, Health, Reimbursement; D016014:Linear Models; D008096:Lithotripsy / Q000191:economics* / Q000706:statistics & numerical data; D010315:Particle Accelerators / Q000191:economics* / Q000600:supply & distribution; D010818:Practice Patterns, Physicians' / Q000191:economics*; D013030:Spain