Should more Australian doctors be salaried than paid by fee-for-service?

Anstey, Matthew H R; Gildfind, Stephen P

doi:10.5694/mja11.11446

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To the Editor: In his Opposing Views article, Travis claims that fee- for-service (FFS) “provides the best transparency, accountability and incentive for everyone”.1 However, FFS models reward volume and intensity, rather than quality of outcomes. Evidence suggests that FFS results in increased numbers of patient visits, investigations and procedures,2 which contribute to inflation in the cost of health care.3

1 Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Mass, USA.
2 The Alfred Hospital, Melbourne, VIC.

Correspondence: gildfind@gmail.com

Competing interests:

No relevant disclosures.

1. Travis DG. Should more Australian doctors be salaried than paid by fee-for-service? Med J Aust 2011; 195: 257. <MJA full text>
2. Gosden T, Forland F, Kristiansen IS, et al. Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians. Cochrane Database Syst Rev 2000; (3): CD002215.
3. Roberts MJ. Getting health reform right: a guide to improving performance and equity. New York: Oxford University Press, 2004.
4. Hennig-Schmidt H, Selten R, Wiesen D. How payment systems affect physicians’ provision behaviour — an experimental investigation. J Health Econ 2011; 30: 637-646.
5. Rosenthal MB. Beyond pay for performance — emerging models of provider-payment reform. N Engl J Med 2008; 359: 1197-1200.

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