PHYSICIAN REMUNERATION METHODS - THE NEED FOR CHANGE AND FLEXIBILITY

Although fee-for-services payment may create an incentive for some phy sicians to make inappropriate clinical decisions that will maximize in come, physicians are no more prone to this kind of behaviour than othe r professionals. Remuneration methods do not necessarily have a predic table effect upon practice, as shown by Hutchison and associates' repo rt in this issue (see pages 653 to 661) that the capitation system use d by Health Service Organizations in Ontario has not had the intended effect of reducing hospital utilization. However, many essential activ ities performed by physicians do not fit in a fee-for-service system. The real challenge is to achieve flexibility and balance in any paymen t system to correct the prevailing gross inequities between different areas of practice and to ensure that disincentives for activities such as health promotion and health service evaluation are eliminated.