From physician to consumer: the effectiveness of strategies to manage health care utilization. Med Care Res Rev 2002 Dec;59(4):455-81
Date
01/02/2003Pubmed ID
12508705Pubmed Central ID
PMC1635490DOI
10.1177/107755802237811Scopus ID
2-s2.0-0036889516 (requires institutional sign-in at Scopus site) 42 CitationsAbstract
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.
Author List
Flynn KE, Smith MA, Davis MKAuthor
Kathryn Eve Flynn PhD Vice Chair, Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Case ManagementConsumer Behavior
Cost Sharing
Decision Making
Drug Utilization Review
Feedback
Gatekeeping
Health Services Research
Humans
Insurance Selection Bias
Managed Care Programs
Organizational Policy
Physician Incentive Plans
Practice Guidelines as Topic
United States
Utilization Review
