Mode of payment, practice characteristics, and physician support for patient self care

Purpose: The purpose of this study was to assess the influence of payment m ode and practice characteristics on physicians' attitudes toward and suppor t of self-care among their patients. It is a common practice for health pla ns and health insurance companies to distribute and make available various self-care services and products to members. These self-care products are ge nerally part of a larger demand-management strategy. The adoption and disse mination of self-care products by both fee-for-service and capitated system s of care suggest an implicit assumption that there is no connection betwee n physician payment mode and the support of self-care products by physician s for their patients. This study empirically examines this assumption. Methods: Physicians from three Northwest communities were sampled and face- to-face interviews were conducted (N=448). Results: The findings show that younger, primary care, and female physician s are more supportive of self care for their patients. Physicians with more income from capitation or salary are also more supportive of self care for their patients. After controlling for other factors, physician mode of pay ment is the only statistically significant predictor of support for self ca re. Research and policy implications are discussed. Conclusions: The findings suggest that physicians who are paid on a capitat ion basis have more motivation to have patients be less reliant on the form al care structure. It is unclear whether the payment mode generates this su pport, or if physicians supportive of patient self care self-select themsel ves into capitated systems of care.