From physician to consumer: the effectiveness of strategies to manage health care utilization.

Full Abstract

Many strategies are commonly used to influence physician behavior in managed care organizations. This review examines the effectiveness of three mechanisms to influence physician behavior:
financial incentives directed at providers or patients, policies/procedures for managing care, and the selection/education of both providers and patients. The authors reach three conclusions. First, all health care systems use financial incentives, but these mechanisms are shifting away from financial incentives directed at the physician to those directed at the consumer. Second, heavily procedural strategies such as utilization review and gatekeeping show some evidence of effectiveness but are highly unpopular due to their restrictions on physician and patient choice. Third, a future system built on consumer choice is contradicted by mechanisms that rely solely on narrow networks of providers or the education of physicians. If patients become the new locus of decision making in health care, provider-focused mechanisms to influence physician behavior will not disappear but are likely to decline in importance.

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Author information

Author/s: Flynn, Kathryn E (KE); Smith, Maureen A (MA); Davis, Margaret K (MK);

Affiliation: University of Wisconsin-Madison, USA.

Grants: R01-AG-19747 (Agency:NIA NIH HHS)

Journal and publication information

Publication Type: Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.

Journal: Medical care research and review : MCRR (Med Care Res Rev), published in United States. (Language: eng)

Reference: 2002-Dec; vol 59 (issue 4) : pp 455-81

Dates: Created 2003/01/01; Completed 2003/01/14; Revised 2008/11/20;

PMID: 12508705, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Humans
Insurance Selection Bias
Managed Care Programs - economics; organization & administration; utilization
Organizational Policy
Physician Incentive Plans
Practice Guidelines as Topic
United States
Utilization Review

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