Theoretical effects of different compensation models .

[Argirios Argiriou]

Theoretical effects of different compensation models 

Modified from Table 9, reference [Lindgren, P. (2014). Compensation in healthcare. Models, effects, recommendations. Stockholm: SNS Förlag.] 

All compensation systems have effects and "side effects".

 Capitation is the basis for compensation for primary care in Sweden, but is often combined with other measures. Good for cost control and you avoid many of the disadvantages that exist with other ways of distributing compensation. BUT the disadvantage of capitation is that there is a risk of passing over the patient to other care providers (referral so that someone else does the work), and low incentives to receive patients, as it does not generate income, only costs.There is also a quality problem, where the low activity (from the Doctors side) have a tendency to lead to "too little" care.

 Fee for service compensation on the other hand, ie. compensation for what you do, e.g. visits, gives "high production", but the disadvantage is selection (you choose easy cases rather than difficult ones), poorer cost control and lower efficiency because you risk doing "too much". There is also a risk that the care provider whips up demand in order to obtain greater revenue, so-called supplier-driven demand. 

 Goal-related compensation provides an opportunity to steer towards higher quality, but has many other problems, especially in primary care where the goals can be very many and conflict with each other.

Source:• [Lindgren, P. (2014). Compensation in healthcare. Models, effects, recommendations. Stockholm: SNS Förlag.]

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