Patient attitudes toward physician financial incentives.
BACKGROUND
Despite concern about the impact of financial incentives on physician behavior, little is known about patients' attitudes toward these incentives.


OBJECTIVE
To assess patient attitudes toward physician compensation models and to explore patient characteristics associated with these attitudes.


METHODS
We mailed a survey to 2000 adult patients in a large New England health maintenance organization. We asked about their trust in their primary care physician; discomfort with compensation models of salary with withhold (salary), fee-for-service with withhold, and group capitation (capitation).


RESULTS
One thousand one hundred twenty-five (56%) of the 2000 patients who responded expressed varying levels of discomfort with the proposed compensation models: 16% for salary, 25% for fee-for-service with withhold, and 53% for capitation (P<.001). Patients who knew their primary care physician was paid through capitation did not report less trust in their primary care physician but still frequently expressed discomfort (46%) with capitation. Among all respondents, those who were younger, white, had better health, had a higher income, were more educated, and who lacked a very trusting relationship with a primary care physician were more likely to report discomfort with both capitation and fee-for-service with withhold. In multivariable analyses, discomfort with capitation was more common among white patients (odds ratio, 2.6; 95% confidence interval, 1.6-4.2), patients with incomes exceeding $20 000 (odds ratio, 3.7; 95% confidence interval, 2.3-6.1), and college-educated patients (odds ratio, 2.0; 95% confidence interval, 1.4-2.7).


CONCLUSIONS
Most patients were uncomfortable with 1 or more of the 3 common methods used to pay physicians. Discomfort was highest with capitation and was more likely among wealthier, well-educated, white patients. With capitation increasing nationally, patients' concerns should be considered in the design of compensation agreements.
Pereira
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AG
Center for Ethics in Managed Care, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA, USA.
Pearson
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D000328:Adult; D000704:Analysis of Variance; D001290:Attitude; D002204:Capitation Fee / Q000706:statistics & numerical data; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006279:Health Maintenance Organizations / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D010361:Patients; D010816:Physician Incentive Plans / Q000191:economics / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000191:economics*; D011336:Probability; D012959:Socioeconomic Factors