Payment Mechanisms and the Composition of Physician Practices: Balancing Cost-Containment, Access, and Quality of Care
Version of Record online: 2 JUL 2014
Copyright © 2014 John Wiley & Sons, Ltd.
Volume 24, Issue 7, pages 895–906, July 2015
How to Cite
2015), Payment Mechanisms and the Composition of Physician Practices: Balancing Cost-Containment, Access, and Quality of Care. Health Econ., 24, 895–906. doi: 10.1002/hec.3069., and (
- Issue online: 2 JUN 2015
- Version of Record online: 2 JUL 2014
- Manuscript Accepted: 6 MAY 2014
- Manuscript Revised: 28 MAR 2014
- Manuscript Received: 11 JUN 2013
- access to primary care;
- mixed payment mechanism
We take explicit account of the way in which the supply of physicians and patients in the economy affects the design of physician remuneration schemes, highlighting the three-way trade-off between quality of care, access, and cost. Both physicians and patients are heterogeneous. Physicians choose both the number of patients and the quality of care to provide to their patients. When determining physician payment rates, the principal must ensure access to care for all patients. When physicians can adjust the number of patients seen, there is no incentive to over-treat. In contrast, altruistic physicians always quality stint: they prefer to add an additional patient, rather than to increase the quality of service provided. A mixed payment mechanism does not increase the quality of service provided with respect to capitation. Offering a menu of compensation schemes may constitute a cost-effective strategy for inducing physicians to choose a given overall caseload but may also generate difficulties with access to care for frail patients. Copyright © 2014 John Wiley & Sons, Ltd.