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What do physicians dislike about managed care? Evidence from a choice experiment

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Abstract

Managed care (MC) imposes restrictions on physician behavior, but also holds promises, especially in terms of cost savings and improvements in treatment quality. This contribution reports on private-practice physicians’ willingness to accept (WTA, compensation asked, respectively) for several MC features. In 2011, 1,088 Swiss ambulatory care physicians participated in a discrete choice experiment, which permits putting WTA values on MC attributes. With the exception of shared decision making and up to six quality circle meetings per year, all attributes are associated with non-zero WTA values. Thus, health insurers must be able to achieve substantial savings in order to create sufficient incentives for Swiss physicians to participate voluntarily in MC plans.

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Notes

  1. Principal GPs have ownerships in their practice, whereas sessional GPs are freelancers (mainly young females with childcare responsibilities) and employees of NHS boards (Scotland).

  2. The RCM (or mixed logit) model is a generalization of the standard logit model. The RCM reduces to the standard model if density f(β) = 1 for β = b and 0 for β ≠ b. Further, the random-intercept logit model (RIM, also called random-effects model) treats the constant as normally distributed with all other coefficients kept fixed.

  3. This is irrelevant to this study, which is of the binary choice type.

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Acknowledgements

The authors would like to express their thanks to Dr. med. Jacques de Haller and Dr. med. Ignazio Cassis from the Swiss Medical Association (FMH) for making the experiment for the present analysis possible. Support by Martina Hersperger and Esther Kraft is also gratefully acknowledged. Special thanks go to Dr. Maria Trottmann and Dr. Harry Telser for their very helpful comments.

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Authors and Affiliations

  1. Department of Economics, University of Zurich, Hottingerstrasse 10, 8032, Zurich, Switzerland

    Maurus Rischatsch & Peter Zweifel

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  1. Maurus Rischatsch
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  2. Peter Zweifel
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Correspondence to Maurus Rischatsch.

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Appendix

See Table 8.

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Rischatsch, M., Zweifel, P. What do physicians dislike about managed care? Evidence from a choice experiment. Eur J Health Econ 14, 601–613 (2013). https://doi.org/10.1007/s10198-012-0405-8

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