Payment by salary or fee-for-service. Effect on health care resource use in the last year of life.

摘要

OBJECTIVE: To investigate the effect of physician payment method on use of health care resources. DESIGN: Retrospective analysis of patient health care data collected for 3 years (1994 to 1996) from the Vital Statistics Department of the British Columbia Ministry of Health. Billing numbers identified physician payment method. SETTING: Salaried and fee-for-service primary care practices in the Capital Region District of Victoria, BC. PARTICIPANTS: A total of 582 patients in their last year of life: 106 were attended by salaried family physicians at a community health clinic; 476 were attended by fee-for-service practitioners. Groups were comparable in age, sex, and geographical location. MAIN OUTCOME MEASURES: Number and cost of specialist and diagnostic services and medications, number of days in hospital (acute and extended care), and main causes of death. RESULTS: None of the dependent measures showed any statistically significant differences based on comparisons between many variables for patients in the two groups. Costs of pharmaceutical, specialist, and diagnostic services were not significantly different for the two groups. There were three main causes of death, according to codes on death certificates: heart disease, malignant neoplasms, and cerebrovascular disease. CONCLUSION: Whether physicians were paid by salary or fee-for-service had no empirical effect on health care resource use.