Patient attitudes toward physician financial incentives

Arch Intern Med. 2001 May 28;161(10):1313-7. doi: 10.1001/archinte.161.10.1313.


Background: Despite concern about the impact of financial incentives on physician behavior, little is known about patients' attitudes toward these incentives.

Objectives: To assess patient attitudes toward physician compensation models and to explore patient characteristics associated with these attitudes.

Methods: We mailed a survey to 2000 adult patients in a large New England health maintenance organization. We asked about their trust in their primary care physician; discomfort with compensation models of salary with withhold (salary), fee-for-service with withhold, and group capitation (capitation).

Results: One thousand one hundred twenty-five (56%) of the 2000 patients who responded expressed varying levels of discomfort with the proposed compensation models: 16% for salary, 25% for fee-for-service with withhold, and 53% for capitation (P<.001). Patients who knew their primary care physician was paid through capitation did not report less trust in their primary care physician but still frequently expressed discomfort (46%) with capitation. Among all respondents, those who were younger, white, had better health, had a higher income, were more educated, and who lacked a very trusting relationship with a primary care physician were more likely to report discomfort with both capitation and fee-for-service with withhold. In multivariable analyses, discomfort with capitation was more common among white patients (odds ratio, 2.6; 95% confidence interval, 1.6-4.2), patients with incomes exceeding $20 000 (odds ratio, 3.7; 95% confidence interval, 2.3-6.1), and college-educated patients (odds ratio, 2.0; 95% confidence interval, 1.4-2.7).

Conclusions: Most patients were uncomfortable with 1 or more of the 3 common methods used to pay physicians. Discomfort was highest with capitation and was more likely among wealthier, well-educated, white patients. With capitation increasing nationally, patients' concerns should be considered in the design of compensation agreements.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analysis of Variance
  • Attitude*
  • Capitation Fee* / statistics & numerical data
  • Fee-for-Service Plans / statistics & numerical data
  • Female
  • Health Care Surveys
  • Health Maintenance Organizations / economics*
  • Health Maintenance Organizations / statistics & numerical data
  • Humans
  • Logistic Models
  • Male
  • Massachusetts
  • Middle Aged
  • Patients*
  • Physician Incentive Plans / economics
  • Physician Incentive Plans / statistics & numerical data*
  • Physician-Patient Relations*
  • Practice Patterns, Physicians' / economics*
  • Probability
  • Socioeconomic Factors