Physician remuneration methods: the need for change and flexibility.

Although fee-for-service payment may create an incentive for some physicians to make inappropriate clinical decisions that will maximize income, physicians are no more prone to this kind of behaviour than other professionals. Remuneration methods do not necessarily have a predictable effect upon practice, as shown by Hutchison and associates' report in this issue (see pages 653 to 661) that the capitation system used by Health Service Organizations in Ontario has not had the intended effect of reducing hospital utilization. However, many essential activities performed by physicians do not fit in a fee-for-service system. The real challenge is to achieve flexibility and balance in any payment system to correct the prevailing gross inequities between different areas of practice and to ensure that disincentives for activities such as health promotion and health service evaluation are eliminated.