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Impacto de sistemas de incentivos na actividade dos médicos : um olhar sobre a literatura com base empírica recente
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RESUMO - Este artigo de revisão, elaborado em Março de 2002, procede
a uma síntese crítica de resultados de onze estudos
empíricos publicados entre 1995 e 2001 sobre o impacto de
diferentes sistemas de incentivos, económicos e não económicos,
na actividade profissional dos médicos, a níveis distintos:
eficiência, qualidade e satisfação profissional.
Numa secção introdutória é explicitado o necessário enquadramento
conceptual do tema, a sua relevância teórica e
política é defendida, e o processo de selecção dos estudos
seleccionados para revisão é descrito.
Na secção seguinte, a evidência empírica é discutida em
três pontos: impacto dos incentivos financeiros na utilização
de recursos dos serviços de saúde, eficiência e custos;
seu impacto na satisfação profissional dos médicos e qualidade
dos cuidados; por fim, efeitos dos aspectos não
financeiros dos sistemas de incentivos na satisfação profissional.
O artigo termina com uma síntese de conclusões, sublinhando
que os sistemas de incentivos distorcem a prática
médica por comparação com um cenário (irreal) de inexistência
de incentivos, que a dimensão do impacto dos incentivos
económicos parece ser menor do que certas formulações
teóricas supõem e que os incentivos não financeiros à
actividade dos médicos têm um papel autónomo considerável
na sua motivação e um forte poder de complementarem
o dos incentivos financeiros. Pelo que, do ponto de vista
político, se recomendam modelos de pagamento a médicos
de tipo misto, com objectivos quantitativos e qualitativos
explicitados, atentos à cultura e especificidades próprias do
grupo profissional em questão e à qualidade do ambiente
organizacional.
ABSTRACT - This review article, completed in March 2002, critically appraises the results of eleven empirical studies published between 1995 and 2001 on the impact of distinct incentive systems, economic and non-economic, in physicians’ professional activity, at different levels: efficiency, quality and professional satisfaction. In an introductory section, a presentation of the conceptual framework of the theme is done, its political and academic relevance is argued, and the selection process of the studies considered is described. In the following section, empirical evidence is analysed in three sub-sections: impact of financial incentives on the utilisation of health services’ resources, efficiency and costs; their impact on physicians’ professional satisfaction and on the quality of care; and, finally, impact of non-financial aspects of incentive systems on professional satisfaction. The article ends with a synthesis of conclusions, stressing out that incentive systems do change physicians’ behaviour, when compared to a (unrealistic) context where incentives do not exist; that the dimension of the impact of economic incentives seems to be smaller than it is usually assumed by theory; and that non-financial incentives have an important role in physicians’ motivation and a strong power of complementing financial incentives. Therefore, from a political point of view, mixed types of physicians’ payment models are recommended, with quantitative and qualitative objectives well explicit, and taking into account the specificities of the cultural and organisational environment related to the selected professional group.
ABSTRACT - This review article, completed in March 2002, critically appraises the results of eleven empirical studies published between 1995 and 2001 on the impact of distinct incentive systems, economic and non-economic, in physicians’ professional activity, at different levels: efficiency, quality and professional satisfaction. In an introductory section, a presentation of the conceptual framework of the theme is done, its political and academic relevance is argued, and the selection process of the studies considered is described. In the following section, empirical evidence is analysed in three sub-sections: impact of financial incentives on the utilisation of health services’ resources, efficiency and costs; their impact on physicians’ professional satisfaction and on the quality of care; and, finally, impact of non-financial aspects of incentive systems on professional satisfaction. The article ends with a synthesis of conclusions, stressing out that incentive systems do change physicians’ behaviour, when compared to a (unrealistic) context where incentives do not exist; that the dimension of the impact of economic incentives seems to be smaller than it is usually assumed by theory; and that non-financial incentives have an important role in physicians’ motivation and a strong power of complementing financial incentives. Therefore, from a political point of view, mixed types of physicians’ payment models are recommended, with quantitative and qualitative objectives well explicit, and taking into account the specificities of the cultural and organisational environment related to the selected professional group.
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Citação
Ferreira, Ana Sofia - Impacto de sistemas de incentivos na actividade dos médicos : um olhar sobre a literatura com base empírica recente = Impact of incentive systems in physicians' activity : a survey of recent studies empirically based. Revista Portuguesa de Saúde Pública. ISSN 0870-9025. Vol. 21, Nº 1 (Janeiro/Junho 2003), p. 7-16
Editora
Universidade Nova de Lisboa, Escola Nacional de Saúde Pública