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Bonus agreements of senior physicians in Switzerland - a qualitative interview study


Fässler, Margrit; Jöbges, Susanne; Biller-Andorno, Nikola (2020). Bonus agreements of senior physicians in Switzerland - a qualitative interview study. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, 158-159:39-46.

Abstract

In Switzerland a legal prohibition of volume-based bonus agreements has been initiated which is expected to take force at the beginning of 2021. Bonus agreements for physicians pose a risk to unbiased indication, possibly leading to over-, under- and misuse of medical care. In order to investigate physicians' perceptions of bonus agreements and reflect on them from an ethical point of view, we conducted a qualitative interview study with Swiss senior physicians. The remuneration system is complex and diverse so that the interviewed physicians were not always able to explain in detail to which targets the variable components of their salary were linked. Study participants were aware of their ethical responsibility regarding non-biased indication and cost-effective medicine. All rejected volume-based bonus agreements. Target agreements should generally have a clear, comprehensible function and always contain a component related to the quality of care delivered. Critical attention should go beyond a narrow focus on volume-based bonus agreements to include other volume-oriented target agreements and reimbursement systems that have the potential to negatively affect patient care.

Abstract

In Switzerland a legal prohibition of volume-based bonus agreements has been initiated which is expected to take force at the beginning of 2021. Bonus agreements for physicians pose a risk to unbiased indication, possibly leading to over-, under- and misuse of medical care. In order to investigate physicians' perceptions of bonus agreements and reflect on them from an ethical point of view, we conducted a qualitative interview study with Swiss senior physicians. The remuneration system is complex and diverse so that the interviewed physicians were not always able to explain in detail to which targets the variable components of their salary were linked. Study participants were aware of their ethical responsibility regarding non-biased indication and cost-effective medicine. All rejected volume-based bonus agreements. Target agreements should generally have a clear, comprehensible function and always contain a component related to the quality of care delivered. Critical attention should go beyond a narrow focus on volume-based bonus agreements to include other volume-oriented target agreements and reimbursement systems that have the potential to negatively affect patient care.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Institute of Biomedical Ethics and History of Medicine
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Medicine (miscellaneous)
Social Sciences & Humanities > Education
Health Sciences > Health Policy
Language:English
Date:December 2020
Deposited On:08 Feb 2021 16:44
Last Modified:09 Feb 2021 21:04
Publisher:Elsevier
ISSN:1865-9217
OA Status:Closed
Publisher DOI:https://doi.org/10.1016/j.zefq.2020.09.002
PubMed ID:33129706

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