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Does the way physicians are paid influence the way they practice? The case of Canadian family physicians' work activity

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  • Sarma, Sisira
  • Devlin, Rose Anne
  • Belhadji, Bachir
  • Thind, Amardeep

Abstract

Objectives To investigate the impact of the mode of remuneration on the work activities of Canadian family physicians on: (a) direct patient care in office/clinic, (b) direct patient care in other settings and (c) indirect patient care.Methods Because the mode of remuneration is potentially endogenous to the work activities undertaken by family physicians, an instrumental variable estimation procedure is considered. We also account for the fact that the determination of the allocation of time to different activities by physicians may be undertaken simultaneously. To this end, we estimate a system of work activity equations and allow for correlated errors.Results Our results show that the mode of remuneration has little effect on the total hours worked after accounting for the endogeneity of remuneration schemes; however it does affect the allocation of time to different activities. We find that physicians working in non-fee-for-service remuneration schemes spend fewer hours on direct patient care in the office/clinic, but devote more hours to direct patient care in other settings, and more hours on indirect patient care.Conclusions Canadian family physicians working in non-fee-for-service settings spend fewer hours on direct patient care in the office/clinic, but devote more hours to direct patient care in other settings and devote more hours to indirect patient care. The allocation of time in non-fee-for-service practices may have some implications for quality improvement.

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  • Sarma, Sisira & Devlin, Rose Anne & Belhadji, Bachir & Thind, Amardeep, 2010. "Does the way physicians are paid influence the way they practice? The case of Canadian family physicians' work activity," Health Policy, Elsevier, vol. 98(2-3), pages 203-217, December.
  • Handle: RePEc:eee:hepoli:v:98:y:2010:i:2-3:p:203-217
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    1. Sarma, Sisira & Thind, Amardeep & Chu, Man-Kee, 2011. "Do new cohorts of family physicians work less compared to their older predecessors? The evidence from Canada," Social Science & Medicine, Elsevier, vol. 72(12), pages 2049-2058, June.
    2. Brekke, Kurt R. & Holmås, Tor Helge & Monstad, Karin & Straume, Odd Rune, 2017. "Do treatment decisions depend on physicians' financial incentives?," Journal of Public Economics, Elsevier, vol. 155(C), pages 74-92.
    3. Cox, James C. & Sadiraj, Vjollca & Schnier, Kurt E. & Sweeney, John F., 2016. "Incentivizing cost-effective reductions in hospital readmission rates," Journal of Economic Behavior & Organization, Elsevier, vol. 131(PB), pages 24-35.
    4. Jiwei Qian & Alex Jingwei He, 2018. "The Bonus Scheme, Motivation Crowding-out and Quality of the Doctor-Patient Encounters in Chinese Public Hospitals," Public Organization Review, Springer, vol. 18(2), pages 143-158, June.
    5. HakemZadeh, Farimah & Sayin, Firat K. & Neiterman, Elena & Zeytinoglu, Isik Urla & Geraci, Johanna & Plenderleith, Jennifer & Lobb, Derek, 2021. "Does an alignment of employment policies and individual preferences affect intention to stay in the profession? Evidence from Canadian Midwives," Health Policy, Elsevier, vol. 125(4), pages 450-458.
    6. Di Matteo, Livio, 2014. "Physician numbers as a driver of provincial government health spending in Canadian health policy," Health Policy, Elsevier, vol. 115(1), pages 18-35.
    7. repec:nip:nipewp:07/2015 is not listed on IDEAS

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