In health economics textbooks, most discussions around incentives for doctors have focused on a comparison of the three most current payment schemes: fee-for-service, capitation, and salary. In general, the scope of analysis is restricted to primary care physicians versus specialist care and care delivered by doctors in hospitals. The story is well known: fee-for-service will incentivize doctors to provide excess care and increase expenditure, but compared to the other schemes it has a positive effect on productivity and quality, although it is not always very clear how quality is defined. Moreover, it is important to specify whether the level of fee is imposed by the payer, or if doctors have some latitude in setting their prices. Capitation will lead to a better control over overall expenditure, but eventually to the detriment of quality, as measured by the unit time per visit and the number of visits. The claim of better control over expenditures can be challenged if—to minimize their effort—GPs systematically refer cases to specialists. Finally, the discussion around salary must take into account the organizational incentives that will inevitably complement the remuneration provided by the employer of the physician.
PUYOU DE POUVOURVILLE, G. (2013). Editorial: Paying Doctors for Performance. European Journal of Health Economics, 14(1), pp. 1-4.