Academic journal article Health Care Financing Review

Health Services Utilization and Physician Income Trends

Academic journal article Health Care Financing Review

Health Services Utilization and Physician Income Trends

Article excerpt

Health services utilization and physician income trends

Statistics from several Organization for Economic Cooperation and Development countries on consumption and cost of health care services, physician workload, and physician earnings are presented. Data are analyzed according to type of physician payment used: fee for service, per case, capitation, or salary. Incentives theoretically embodied in each payment method are often offset by other factors--scale of charges, patient out-of-pocket payment, and patient access or physician activity restrictions. Moreover, the impact of payment method on use appears to be weaker than the impact of such factors as population morbidity, national health insurance, professional ethics, and medical technology.


This article is a presentation of a set of statistics gathered to describe the behavior of patients and doctors, the consumption and cost of health care services, and physician earnings in a number of Organization for Economic Cooperation and Development (OECD) countries. The countries concerned are Canada, Denmark, France, the Federal Republic of Germany (hereafter called Germany), Italy, Japan, the Netherlands, the United Kingdom, and the United States. (In Canada, health care systems differ somewhat from province to province. Quebec's system is studied in more detail here because some aspects of its system of remuneration for physicians are unique.) The data are studied in relation to the methods used in the different countries to compensate physicians. First, the scope and comparability of the data available across the countries as well as analysis of the possible impact of the remuneration methods on the behavior of patients and their doctors are discussed.

Methodological remarks

The aggregate statistical data used in this article were derived from a variety of different sources. In some cases, various primary data were combined so as to get as comparable estimates as possible. In the "Technical note," the sources and computations used for each parameter are listed. It must be stressed that the concepts and definitions used in the different countries--and sometimes inside the same country--vary. Therefore, the parameters used to describe the operation of the health care system in general and the activity or income of physicians in particular are not identical even though the term used may be the same.

Depending on the method of data collection--surveys of households, surveys of physicians, use of health insurance records, or use of national accounts--the data cover a different scope of population, practitioners, and expenses. The discrepancies are sometimes real, but sometimes they are only apparent. For example, using data from the National Ambulatory Medical Care Survey of the National Center for Health Statistics (NCHS), one could quote the figure of 2.7 physician contacts per person per year in the United States during 1985. On the other hand, using 1985 NCHS data from the National Health Interview Survey, one could quote the figure of 5.3 physician visits per person per year. The explanation of the apparent difference lies in the fact that the first estimate refers only to office visits. In other countries, the scope of the data reported by national health insurance funds is generally more restricted than that of data reported in patient interviews. In most cases, the explanations of the differences can be found by careful reading of the detailed methodological appendixes of publications. The data selected for this study are as comparable across countries as possible. However, some bias might be introduced in the intercountry comparisons by the fact that data are not available for all countries on a yearly basis.

The influence of a particular method of payment on the functioning of a health system should, strictly speaking, be assessed in terms of the outcome of the incentive or disincentive effects of each of its dimensions, e. …

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