Does a year make a difference? Changes in physician satisfaction and perception in an increasingly capitated environment

BACKGROUND: Although capitation has become an increasingly common method of payment for heath care, little is known about changes in physician satisfa ction as they become more experienced working in a capitated environment. METHODS: We surveyed the members of a physician hospital organization at an urban teaching hospital in the summers of 1996 and 1997. In 1996, fully ca pitated contracts covered <5%, of patients under 65 years of age, but that figure increased to nearly 25% by 1997. We assessed physicians' satisfactio n with their practice, compared satisfaction under fee-for-service and capi tated payment, and evaluated ethical issues related to capitation. RESULTS: In 1996, we surveyed 587 physicians with direct patient care respo nsibilities, of whom 62% responded; 51% of 520 physicians responded in 1997 . Overall satisfaction was 57% in 1996 and 71% in 1997. Among physicians wh o responded in both years, overall satisfaction was unchanged, but increase s in satisfaction were noted for patient load (an increase of 0.5 points on a five-point scale, P <0.01), time to discuss patient needs (an increase o f 0.3 points, P <0.01), and helpfulness of care coordination (an increase o f 0.5 points, P = 0.02). In a direct comparison between fee-for-service and capitation, physicians were more satisfied with both methods of payment in 1997 than they were in 1996, but they were much more satisfied with fee-fo r-service in both years. For many individual indicators, the difference in satisfaction between fee-for-service and capitation increased between 1996 and 1997. CONCLUSION: When introduced to capitation, physicians had strong negative p erceptions about it. After a year's experience, satisfaction with capitatio n improved, but perceived differences between capitation and fee-for-servic e grew even larger. Thus, physicians have serious concerns about capitation that may not be alleviated by experience,vith it. (C) 1999 by Excerpta Med ica, Inc.