PMID- 35790981
OWN - NLM
STAT- MEDLINE
DCOM- 20220707
LR  - 20220716
IS  - 1472-6963 (Electronic)
IS  - 1472-6963 (Linking)
VI  - 22
IP  - 1
DP  - 2022 Jul 5
TI  - Effects of fee-for-service, diagnosis-related-group, and mixed payment systems on 
      physicians' medical service behavior: experimental evidence.
PG  - 870
LID - 10.1186/s12913-022-08218-5 [doi]
LID - 870
AB  - BACKGROUND: Healthcare reforms in many countries have shown a movement from pure 
      payment systems to mixed payment systems. However, there remains an insufficient 
      understanding of how to design better mixed payment systems and how such systems, 
      especially Diagnosis-Related-Group (DRG)-based systems, benefit patients. We 
      therefore designed a controlled laboratory experiment to investigate the effects 
      of fee-for-service (FFS), DRG, and mixed payment systems on physicians' service 
      provision. METHODS: A total of 210 medical students were recruited from Capital 
      Medical University as subjects. They, in the role of physicians, were randomly 
      divided into seven groups and chose the quantity of medical services for 
      different patient types under pure FFS, pure DRG, or mixed payment schemes that 
      included two FFS-based mixed payment schemes and three DRG-based mixed payment 
      schemes. There were five rounds of each group of experiments, and each subject 
      made 18 decisions per round. The quantity of medical services provided by 
      subjects were collected. And relevant statistics were computed and analyzed by 
      nonparametric tests and random effects model. RESULTS: The results showed that 
      the physicians' overprovision (underprovision) of services under FFS (DRG) 
      schemes decreased under mixed payment schemes, resulting in higher benefit to 
      patients under mixed payment schemes. Patients' health conditions also affected 
      physicians' behavior but in different directions. Higher disease severity was 
      associated with higher deviation of physicians' quantity choices from the optimal 
      quantity under DRG and DRG-based mixed payment schemes, while the opposite was 
      found for FFS and FFS-based mixed payment schemes. CONCLUSIONS: Mixed payment 
      systems are a better way to balance physicians' profit and patients' benefit. The 
      design of mixed payment systems should be adjusted according to the patient's 
      health conditions. When patients are in lower disease severity and resource 
      consumption is relatively small, prospective payments or mixed systems based on 
      prospective payments are more suitable. While for patients in higher disease 
      severity, retrospective payments or mixed systems based predominantly on 
      retrospective payments are better.
CI  - (c) 2022. The Author(s).
FAU - Li, Xing
AU  - Li X
AD  - School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai 
      Street, Fengtai District, Beijing, 100069, China.
FAU - Zhang, Yue
AU  - Zhang Y
AD  - School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai 
      Street, Fengtai District, Beijing, 100069, China.
FAU - Zhang, Xinyuan
AU  - Zhang X
AD  - School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai 
      Street, Fengtai District, Beijing, 100069, China.
FAU - Li, Xinyan
AU  - Li X
AD  - School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai 
      Street, Fengtai District, Beijing, 100069, China.
FAU - Lin, Xing
AU  - Lin X
AD  - School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai 
      Street, Fengtai District, Beijing, 100069, China.
FAU - Han, Youli
AU  - Han Y
AD  - School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai 
      Street, Fengtai District, Beijing, 100069, China. hanyouli@ccmu.edu.cn.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20220705
PL  - England
TA  - BMC Health Serv Res
JT  - BMC health services research
JID - 101088677
SB  - IM
MH  - Diagnosis-Related Groups
MH  - *Fee-for-Service Plans
MH  - Health Care Reform
MH  - Humans
MH  - *Physicians
MH  - Retrospective Studies
PMC - PMC9258053
OTO - NOTNLM
OT  - Experimental economics
OT  - Mixed payment
OT  - Physicians' behavior
COIS- None declared.
EDAT- 2022/07/06 06:00
MHDA- 2022/07/08 06:00
PMCR- 2022/07/05
CRDT- 2022/07/05 23:33
PHST- 2022/01/16 00:00 [received]
PHST- 2022/06/14 00:00 [accepted]
PHST- 2022/07/05 23:33 [entrez]
PHST- 2022/07/06 06:00 [pubmed]
PHST- 2022/07/08 06:00 [medline]
PHST- 2022/07/05 00:00 [pmc-release]
AID - 10.1186/s12913-022-08218-5 [pii]
AID - 8218 [pii]
AID - 10.1186/s12913-022-08218-5 [doi]
PST - epublish
SO  - BMC Health Serv Res. 2022 Jul 5;22(1):870. doi: 10.1186/s12913-022-08218-5.