Sistemas de remuneração baseados em incentivos financeiros e seus efeitos na produção hospitalar

Abstract

Physicians' financial compensation systems and their implications for the provision of health care services provided draw the attention of researchers, seeking to understand how physicians respond to financial incentives paid in the form of fixed and variable remuneration. This thesis aimed to analyze the effects of these financial incentives on hospital production, verifying whether: i) the physician’s variable remuneration increases the volume of hospital production; ii) the effect of variable remuneration on hospital production varies according to the medical specialty; iii) cooperation between medical specialties increases the volume of hospital production and; iv) the physician's production volume is influenced by competition among members from the same specialty. The sample consists of monthly data from 82 doctors from 21 specialties, from May 2013 to September 2017, resulting in a final sample of 3,504 observations. To achieve the goals of the study, linear models were estimated using the pooled ordinary least squares (POLS) method. The results indicate that variable remuneration affected hospital production, including the demand for expensive procedures, however, it did not affect highly complex procedures. Also, there is evidence that variable remuneration affected the hospital production in a heterogeneous way among the specialties. In turn, greater cooperation between the specialties had positive effects on the number of appointments and negative effects on the number of exams. However, the effects were not significant for the total production, the proportion of highly complex and expensive procedures. Competition between doctors of the same specialty resulted in an average increase only for the proportion of expensive procedures. Finally, it was observed that the concentration in the specialties resulted in an increase in the average of total procedures, number of appointments and proportion of highly complex procedures. The findings of this thesis contribute to a better understanding of the effects of different forms of physician remuneration, as well as the implications of financial incentives for hospital production, especially for hospitals maintained with public resources, thus contributing to the formulation of public policies for the health sector.