Financial Incentives to Physician’s Behaviour

Abstract

The considerable increase of health care expenditures in the F.R.G. has caused a number of new health policy arrangements. One of these measures was to regulate the remuneration for surgical services in a way that operations would be transferred from the stationary to the less expensive ambulatory sector of the health care system. This regulation, agreed upon by the Association of Bavaria’s Sick-fund Affiliated Physicians and the Associations of the Statutory Sickfunds of Bavaria in October 1980, provides that, in cases of ambulatory surgery, an extra-fee is paid in addition to the original fee for each surgical service. This extra fee is bound to the condition that staff and equipment of operating facilities comply with certain standards. Since it is to be paid to the owners of the operating facilities, it is either the practice-based physicians or the hospitals who receive this extra-fee, depending on where ambulatory surgery is carried out. This extra- fee regulation takes into account that many physicians consider ambulatory surgery justifiable only on the basis of such standards, but that the fees for surgical services do not cover the additional costs that arise when these standards are to be fulfilled. There are three different extra-fees, related in their amount to the remuneration for the respective services in the fee-schedule. By this the average remuneration for ambulatory surgical services has about doubled in 1982. This paper tries to answer the question whether this alteration of the fee-schedules has led to the intended effects on surgical activities of physicians.