Performance-based reimbursement in health care. Consequences for physicians' cost awareness and work environment.
BACKGROUND
The funding and structure of health care is currently undergoing major changes. The impact of such changes on professional behaviour and working conditions have not been widely studied in Europe. The two aims of this study were to prospectively assess the impact of performance-based reimbursement on physicians' attitudes and self-assessed professional behaviour, related to cost awareness, as well as their working conditions.


METHODS
Physicians in Stockholm County Council (with a performance-based reimbursement system) and physicians in eleven Swedish councils without performance-based reimbursement were examined simultaneously in 1994. This was a cross-sectional questionnaire study.


RESULTS
The results show a heightened cost awareness among physicians in Stockholm but also greater discontent with working condition factors such as decision latitude, job satisfaction and personal well-being.


CONCLUSIONS
These results suggest that in order to counteract physicians discontent as a result of altered structure and increased focus on performance-based reimbursement, the autonomy and influence of physicians over the work processes need to be considered.
Forsberg
Ewa
E
Centre for Development of Health Services, Box 4402, S-102 68 Stockholm, Sweden. ewa.forsberg@smd.sll.se
Axelsson
Runo
R
Arnetz
Bengt
B
D000328:Adult; D001291:Attitude of Health Personnel; D001364:Awareness / Q000502:physiology*; D003430:Cross-Sectional Studies; D003657:Decision Making / Q000502:physiology; D003695:Delivery of Health Care / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000191:economics*; D012052:Reimbursement, Incentive / Q000191:economics*; D011795:Surveys and Questionnaires; D013548:Sweden; D016526:Workload / Q000706:statistics & numerical data