Capitation payment, length of visit, and preventive services: evidence from a national sample of outpatient physicians.
OBJECTIVE
To test the hypothesis that capitation payment to physicians reduces the length of physician-patient encounters but increases use of preventive and health counseling services.


METHODS
Cross-sectional analysis of data from the National Ambulatory Medical Care Survey of outpatient physicians and their office staff (1997 and 1998).


METHODS
A random national sample of 46,320 ambulatory care visits was used. Weight-adjusted multivariate regression techniques were utilized to examine the effects of capitation on duration of physician visit and number of preventive and health counseling services.


RESULTS
Physicians spent 5.6% less time (P < .01) with patients in capitated plans than with those in noncapitated plans. The effect of payment method on length of visit was 3.5 times stronger among physicians receiving only capitated payment, compared with physicians receiving only noncapitated payment. Patients in capitated plans were 17% more likely to receive health counseling services (P < .01) than patients in noncapitated plans. Patients under capitation were 3% more likely to receive preventive services compared to patients in non-health maintenance organizations, noncapitated plans (P < .05).


CONCLUSIONS
Capitation is associated with a modest decrease in the amount of time physicians spend with their patients and with increased receipt of preventive and health counseling services, on average. These trends are driven by physicians who receive capitated payment predominantly. Physicians with a mix of patients from capitated and noncapitated plans spend approximately equal time with each type of patient, which reflects an ethic of impartiality in medical judgment.
Balkrishnan
Rajesh
R
Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. rbalkris@wfubmc.edu
Hall
Mark A
MA
Mehrabi
Don
D
Chen
G John
GJ
Feldman
Steven R
SR
Fleischer
Alan B
AB
D000368:Aged; D002204:Capitation Fee; D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine; D006279:Health Maintenance Organizations; D006302:Health Services Research; D006801:Humans; D009819:Office Visits; D017063:Outcome Assessment, Health Care; D010817:Physician-Patient Relations; D011314:Preventive Health Services / Q000191:economics / Q000458:organization & administration*; D012494:Sampling Studies; D013996:Time and Motion Studies; D014481:United States