Capitation and its effects on physician satisfaction.
OBJECTIVE
Capitation is an increasingly common method of paying physicians, but few data exist on its impact on physician satisfaction. This study examines the perceived effects of capitation on physician satisfaction at a large, academic medical center.


METHODS
Survey of physicians at a single, tertiary care hospital.


METHODS
Physicians in a physician hospital organization were surveyed at an urban teaching hospital which received capitation for 5% of patients at the time of the survey but was preparing for a sharp increase in capitation. We used a 5-point Likert scale to assess physicians' satisfaction with their practice, and to compare satisfaction under fee-for-service and expected satisfaction under capitation.


RESULTS
Of the 734 physicians surveyed, 147 were excluded because they had no direct patient care responsibilities. Of the remaining 587 physicians, 363 replied, giving a response rate of 62%. Overall, 57% of physicians were satisfied with their practice. Compared to their satisfaction under fee-for-service reimbursement, they were much less satisfied with their ability to care for capitated patients (17 of 19 questions, p < 0.05). The greatest differences were for freedom to order necessary tests and freedom to obtain referrals (0.9 and 0.8 on the 5-point scale, respectively, both p < 0.0001). Multiple logistic regression analyses revealed four independent predictors of overall satisfaction: patient load (OR = 2.7, 95% CI = 1.9-3.9), efficiency in resource utilization (OR = 1.5, 95% CI = 1.1-2.1), perceived employment stability (OR = 1.7, 95% CI = 1.3-2.2), and control over clinical time schedule (OR = 1.6, 95% CI = 1.2-2.0).


CONCLUSIONS
Physicians initially encountering capitation payment have strong negative perceptions about it, even for areas in which some policy experts expect capitation to benefit patient care. Physician education and focusing on management relations may help smooth the transition to capitated reimbursement.
Tyrance
P H
PH
Harvard Medical School and Kennedy School of Government, Harvard University, Boston, MA, USA.
Sims
S
S
Ma'luf
N
N
Fairchild
D
D
Bates
D W
DW
D000046:Academic Medical Centers / Q000191:economics; D001291:Attitude of Health Personnel; D002204:Capitation Fee; D003625:Data Collection; D006759:Hospital-Physician Joint Ventures / Q000191:economics*; D006801:Humans; D007588:Job Satisfaction; D008505:Medical Staff, Hospital / Q000523:psychology*; D017009:Professional Autonomy; D011787:Quality of Health Care; D012044:Regression Analysis; D020414:Risk Sharing, Financial; D014481:United States; D000078329:Workforce