Vortragssitzung
Physician Payment
Vorträge
Should Physicians Team Up to Treat Chronic Diseases?
Malte Griebenow, HCHE
Einleitung / Introduction
Chronic diseases are responsible for large economic and health related costs. High-quality physician care can help to alleviate these costs by reducing the number of complications, related health problems, and specialist visits in the future. Some authors suggest that chronic diseases should be treated in multidisciplinary physician teams in order to facilitate cooperation between the physicians. In this paper I present a theoretical model of chronically ill patients who may require treatment from both a generalist (PCP) and a specialist. The aim of this paper is to determine whether, and under which conditions, it is desirable to organize the treatment of chronic patients in a physician team.
Methode / Method
Patients can be more or less severely ill. If they are severely ill, they suffer a periodical health loss. The patient’s disease severity changes probabilistically over time according to a Markovian process. Both the probability that a patient’s state improves and the probability that it deteriorates depend on which physician treats the patient and on the treating physician’s effort. Efficient treatment calls for high effort PCP treatment if the patient is mildly ill and high effort specialist treatment otherwise. Physicians can be organized in a team or solo practices. In the team the physicians can coordinate their referral- and effort decisions. This can be advantageous for the payer since the physicians are incentivized to save on the future costs of care. However, physician cooperation comes with the risk of the physicians colluding against the payer in order to obtain greater profits. As extensions the impact of physician altruism and flat treatment fees in the team are examined.
Ergebnisse / Results
Efficient effort levels and referrals can only be achieved in a physician team if the difference in expected treatment costs between patient types is larger for the PCP than the specialist. In this case it is always optimal for the physicians to form a team since the first-best can never be reached in the solo practices. Treatment fees for the PCP should include a markup, whereas specialists should bear part of their treatment costs. However, if the difference in expected treatment costs is larger for the specialist than the PCP, it can be better to deliver care through physicians who work in solo practices. The reason for this is that in solo practices adverse patient selection incentives only affect the specialist, whereas in the team they also affect the decisions of the PCP.
Zusammenfassung / Conclusion
Despite the existence of coordination problems, solo practices can be more socially efficient than teams if the difference in expected treatment costs between patient types is larger for the specialist than the PCP.
AutorInnen
Malte Griebenow, HCHE
How to Pay Primary Care Physicians for SARS-CoV-2 Vaccinations: An Analysis of 43 EU and OECD Countries
Ricarda Milstein
Einleitung / Introduction
Vaccinations are crucial to fighting SARS-CoV-2, and in most countries high coverage rates can probably only be achieved by involving primary care physicians (PCPs). Compared to most other providers, PCPs administer vaccines regularly and tend to have a closer relationship to their patients. The payment schemes used to compensate PCPs for vaccination services differ from country to country, and each scheme has features that vary in their impact on the provision of these services. In this paper, we aimed to explore how payment schemes for SARS-CoV-2 vaccination in 43 countries differed with regard to (i) the type of payment scheme, (ii) the amount paid, (iii) the degree of bundling, and (iv) the use of pay-for-performance elements.
Methode / Method
We collected information on payments and health system characteristics, such as PCP income and employment status, in all EU and OECD countries over time. We regressed the payment amount on the income of PCPs for countries with activity-dependent schemes, and we interpreted the residuals of this regression as a vaccination payment index. We discuss the design and development of payment schemes in the context of the countries’ health system characteristics.
Ergebnisse / Results
The majority of countries (30/43) had chosen payment schemes that reward PCPs for the activity they perform. Seventeen countries paid less per vaccination than the income-adjusted average, whereas 13 countries paid more. Payments ranged from $4.08 per vaccination in Lithuania to $42.39 in Ireland. The values of the vaccination payment index were highly heterogeneous across the 43 countries, with Canada (British Columbia) paying $11.93 less and Ireland paying $20.24 more than the income-adjusted average per vaccination. Twelve countries used payment-for-performance elements.
Zusammenfassung / Conclusion
Our cross-country comparison with comparative data and our intuitive vaccination payment index can guide policymakers in how to design a payment scheme for vaccinations against COVID-19 that best meets their country’s needs. Our overview on how 43 EU and OECD countries pay PCPs for providing vaccinations against COVID-19 supports them in making informed decisions on the payment amounts, degree of bundling, and use of payment-for-performance elements.