Skip to main content

Paying Physicians as Agents: Fee-For-Service, Caption, or Hybrids?

  • Chapter
Health Care Policy and Regulation

Part of the book series: Topics in Regulatory Economics and Policy Series ((TREP,volume 20))

Abstract

How physicians should be paid is a key question for privately managed HMOs and insurance plans, administrators of public insurances, and public policy makers. The popular concern usually is with the level of physician net income—do doctors make too much?—but the analytical problem is frequently more concerned with how a given income is earned, and what consequences it has for substitute or compliment inputs and services physicians can control. After all, physician net income is only 12% of total health spending; cutting it by 10% would do little good, but increasing it by 40% might be a bargain if the increase could be coupled with financial incentives to reduce the use of other inputs.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Baumgardner, J. 1992. “Medicare Physician-Payment Reform and the Resource-Based Relative Value Scale: A Recreation of Efficient Market Prices?” American Economic Review 82 (No. 4, September): 1027–1030.

    Google Scholar 

  • Clinton, W.J. 1993. President Clinton’s Health Care Reform Proposal and Health Security Adas Presented to Congress on October 27,1993. Chicago: Commerce Clearing House, Inc.

    Google Scholar 

  • Ellis, R., and T. McGuire. 1986. “Provider Behavior Under Prospective Reimbursement Cost Sharing and Supply.”Journal of Health Economics 5 (No. 2, June): 129–151.

    Article  Google Scholar 

  • Ellis, R., and T. McGuire. 1990. “Optimal Payment Systems for Health Services.” Journal of Health Economics 9(4): 375–396.

    Article  Google Scholar 

  • Goddeeris, J. 1984. “Insurance and Incentives For Innovation in Medical Care.” Southern Economic Journal 51 (No. 2, October): 503–539.

    Article  Google Scholar 

  • Granneman, T, et al. 1986. “Estimating Hospital Costs: A Multiple-Output Analysis.” Journal of Health Economics 5 (No. 2, June): 107–127.

    Article  Google Scholar 

  • Hillman, A. 1987. “Financial Incentives for Physicians in HMOs: Is There a Conflict of Interest?” The New England Journal of Medicine 315: 511–513.

    Article  Google Scholar 

  • Hsiao, W. 1988. “Resource-based Relative Values: An Overview.” JAMA 260 (No. 16, Oct. 28): 2347–2353.

    Article  Google Scholar 

  • Kerstein, J. 1990. “A Theoretical and Empirical Study of Physician Compensation Arrangements.” Dissertation for Ph.D. in Health Care Systems at the Wharton School, University of Pennsylvania.

    Google Scholar 

  • Kwon, S. 1993. “Payment Systems, Provider Incentives, and Consumer Information in Health Care Markets: Physician Compensation Arrangements.” Dissertation for Ph.D. in Health Care Systems at the Wharton School, University of Pennsylvania, 1993.

    Google Scholar 

  • Langweil, K., and M. Pauly. 1986. “Physician Payment Reform: Who Shall Be Paid?” Medical Care Review 43 (No. 1, Spring): 101–132.

    Article  Google Scholar 

  • Pauly, M., et al. 1989. “Methods for Pricing the Technical Components of Diagnostic Tests.” DHHS HCFA, Contract No. 99-C-99/69/5-01 (April).

    Google Scholar 

  • Pauly, M. 1980. Doctors and Their Workshops. Chicago: University of Chicago Press.

    Google Scholar 

  • Pauly, M. 1991. “Fee Schedules and Utilization.” In Regulating Doctor’s Fees: Competition Benefits, and Controls Under Medicare, edited by H.E. Frech, 288–305.

    Google Scholar 

  • Sloan, F. 1975. “Physician Supply Behavior in the Short Run.” Industrial and Labor Relations Review (July): 594–613.

    Google Scholar 

  • Welch, W.P., et al. 1990. “Contractual Relationships between HMOs and Primary Care Physicians: Three-tiered HMOs and Risk Pools.” Medical Care 30 (February): 136–148.

    Google Scholar 

  • Baumgardner, J.R. 1992. “Medicare Physician-Payment Reform and the Resource-Based Relative Value Scale: A Re-creation of Efficient Market Prices?” American Economic Review 82 (September): 1027–1030.

    Google Scholar 

  • Breyer, F. 1987. “The Specification of a Hospital Cost Function: A Comment on the Recent Literature.” Journal of Health Economics 6 (June): 147–157.

    Article  Google Scholar 

  • Hadley, J. 1991. “Theoretical and Empirical Foundations of the Resource-based Relative Value Scale.” In Regulating Doctors’ Fees: Competition, Benefits, and Controls Under Medicare, edited by H.E. Frech, III, 97–125. Washington, DC: American Enterprise Institute Press.

    Google Scholar 

  • Joskow, P.J., and N.L. Rose. 1989. “The Effects of Economic Regulation.” In Handbook of Industrial Organization, Volume II, edited by R. Schmalensee and R.D. Willig, 1449–1506. Amsterdam: Elsevier Science Publishers B.V.

    Chapter  Google Scholar 

  • PPRC. 1993. “Fee Update and Medicare Volume Performance Standards for 1994.” Physician Payment Review Commission, publication No. 93-1 (May 15).

    Google Scholar 

  • Stearns, S.C., B.L. Wolfe, and D.A. Kindig. 1992. “Physician Responses to Fee-for Service and Capitated Payment.” Inquiry 29 (Winter): 416–425.

    Google Scholar 

  • Stigler, G.J., and C. Friedland. 1962. “What Can Regulators Regulate: The Case of Electricity.” Journal of Law and Economics 5 (October): 1–16.

    Article  Google Scholar 

  • Vita, M.G. 1990. “Exploring Hospital Production Relationships with Flexible Functional Forms.” Journal of Health Economics 9 (June): 1–21.

    Article  Google Scholar 

  • Zuckerman, S., W.P. Welch, and G.C. Pope. 1990. “A Geographic Index of Physician Practice Costs.” Journal of Health Economics 9 (June): 39–69.

    Article  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1995 Springer Science+Business Media New York

About this chapter

Cite this chapter

Pauly, M.V. (1995). Paying Physicians as Agents: Fee-For-Service, Caption, or Hybrids?. In: Abbott, T.A. (eds) Health Care Policy and Regulation. Topics in Regulatory Economics and Policy Series, vol 20. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-2219-5_9

Download citation

  • DOI: https://doi.org/10.1007/978-1-4615-2219-5_9

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-5932-6

  • Online ISBN: 978-1-4615-2219-5

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics