Financial incentives and patient selection: Hospital physicians' views on cream skimming and economic management focus in Norway. Issue 1 (January 2021)

• Record Type: Journal Article
• Authors: Kjøstolfsen, Gjertrud Hole; Baheerathan, Janusha; Martinussen, Pål E.; Magnussen, Jon
• Is Part Of: Health policy. Volume 125:Issue 1(2021)
• Page Start: 98
• Page End: 103
• Publication Date: 2021-01
• Subjects: Cream skimming -- Physician views -- Activity based financing -- Survey data; Medical education -- Periodicals; Medical policy -- Periodicals; Delivery of Health Care -- Periodicals; Education, Medical -- Periodicals; Health Education -- Periodicals; Health Planning -- Periodicals; Public Policy -- Periodicals; Enseignement médical -- Périodiques; Politique sanitaire -- Périodiques; Medical education; Medical policy; Periodicals; Electronic journals; Electronic journals; 362.1
• DOI: 10.1016/j.healthpol.2020.10.011
• Languages: English
• ISSNs: 0168-8510

Abstract

Highlights: Physicians differ in to what extent they believe the system encourages cream skimming. Physicians in leading positions are less concerned about cream skimming. Physicians believe that management puts much emphasis on economic issues. Abstract: This paper uses survey data to analyse physician views on the risk of cream skimming under a system with activity based financing (ABF) for hospital services. We used data from two nation-wide physician surveys. A survey undertaken in 2006 captures views following a large NPM-inspired structural reform in 2002. In contrast, a survey undertaken in 2016 captures views after a period of a higher degree of institutional and financial stability. We find that the majority of physicians believed that the 2002 reform both provided incentives for and led to more cream skimming. In 2016, however there is less consensus among physicians about the extent of cream skimming. Looking at different types of physicians we find some indications that physicians in leading positions are less likely to view cream skimming as a problem. However, there is concern that hospital management in general puts too much emphasis on economic issues.