TAILIEUCHUNG - Chapter 003. Decision-Making in Clinical Medicine (Part 5)

Economic Incentives Economic incentives are closely related to the other two categories of practice-modifying factors. Financial issues can exert both stimulatory and inhibitory influences on clinical practice. In general, physicians are paid on a feefor-service, capitation, or salary basis. In fee-for-service, the more the physician does, the more the physician gets paid. The economic incentive in this case is to do more. When fees are reduced (discounted fee-for-service), doctors tend to increase the number of services billed for. Capitation, in contrast, provides a fixed payment per patient per year, encouraging physicians to take on more patients but to provide. | Chapter 003. Decision-Making in Clinical Medicine Part 5 Economic Incentives Economic incentives are closely related to the other two categories of practice-modifying factors. Financial issues can exert both stimulatory and inhibitory influences on clinical practice. In general physicians are paid on a fee-for-service capitation or salary basis. In fee-for-service the more the physician does the more the physician gets paid. The economic incentive in this case is to do more. When fees are reduced discounted fee-for-service doctors tend to increase the number of services billed for. Capitation in contrast provides a fixed payment per patient per year encouraging physicians to take on more patients but to provide each patient with fewer services. Expensive services are more likely to be affected by this type of incentive than inexpensive preventive services. Salary compensation plans pay physicians the same regardless of the amount of clinical work performed. The incentive here is to see fewer patients. In summary expert clinical decision-making can be appreciated as a complex interplay between cognitive devices used to simplify large amounts of complex information interacting with physician biases reflecting education training and experience all of which are shaped by powerful sometimes perverse external forces. In the next section a set of statistical tools and concepts that can assist in making clinical decisions in the presence of uncertainty are reviewed. Quantitative Methods to Aid Clinical Decision-Making The process of medical decision-making can be divided into two parts 1 defining the available courses of action and estimating the likely outcomes with each and 2 assessing the desirability of the outcomes. The former task involves integrating key information about the patient along with relevant evidence from the medical literature to create the structure of a decision. The remainder of this chapter will review some quantitative tools available to assist the

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