Physician reimbursement and the medical encounter: An observational study in Dutch pediatrics

Pediatrician reimbursement is shifting from fee-for-service to a fixed sala ry In the Netherlands, as physicians working on a fee-for-service basis hav e a financial interest in talking less and in carrying out more diagnostic tests and investigations, it may be questioned whether this will influence the structure and content of medical visits. With use of 302 videotaped out patient encounters with either salaried or fee-for-service pediatricians, d ifferences were examined in visit length, number of requests for diagnostic tests and investigations (laboratory test, endoscopy and radiography), ped iatrician-parent communication behaviors, and patient satisfaction. This in vestigation was carried out by means of bivariate and multilevel analysis. The results showed that the visits with salaried pediatricians lasted almos t 4 minutes longer. This surplus time was not spent on social talk or on a more elaborate history taking but was used to provide more information and advice. In addition, salaried pediatricians engaged in more empathic behavi or toward the patient, thereby facilitating a therapeutic relationship. No differences were found in the number of diagnostic tests and investigations or in patient satisfaction. It may be concluded that history taking and so cial talk took place in a fixed part of the visit. Salaried pediatricians s pent more time on exchanging information with their patients and paid more attention to patient concerns and emotions. As the reimbursement shift is n ot likely to diminish the number of diagnostic tests and investigations and will increase the length of the medical visits, overall financial benefits may be limited.