Mode of payment, practice characteristics, and physician support for patient self care.
OBJECTIVE
The purpose of this study was to assess the influence of payment mode and practice characteristics on physicians' attitudes toward and support of self-care among their patients. It is a common practice for health plans and health insurance companies to distribute and make available various self-care services and products to members. These self-care products are generally part of a larger demand-management strategy. The adoption and dissemination of self-care products by both fee-for-service and capitated systems of care suggest an implicit assumption that there is no connection between physician payment mode and the support of self-care products by physicians for their patients. This study empirically examines this assumption.


METHODS
Physicians from three Northwest communities were sampled and face-to-face interviews were conducted (N=448).


RESULTS
The findings show that younger, primary care, and female physicians are more supportive of self care for their patients. Physicians with more income from capitation or salary are also more supportive of self care for their patients. After controlling for other factors, physician mode of payment is the only statistically significant predictor of support for self care. Research and policy implications are discussed.


CONCLUSIONS
The findings suggest that physicians who are paid on a capitation basis have more motivation to have patients be less reliant on the formal care structure. It is unclear whether the payment mode generates this support, or if physicians supportive of patient self care self-select themselves into capitated systems of care.
Hibbard
J H
JH
Department of Planning, Public Policy, and Management, University of Oregon, Eugene, Oregon, USA. jhibbard@oregon.uoregon.edu
Greenlick
M R
MR
Kunkel
L E
LE
Capizzi
J
J
D001291:Attitude of Health Personnel; D002204:Capitation Fee; D018588:Fee-for-Service Plans; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D015205:Northwestern United States; D010820:Physicians / Q000191:economics / Q000523:psychology; D010818:Practice Patterns, Physicians'; D012648:Self Care / Q000191:economics / Q000706:statistics & numerical data*