THE EFFECT OF EQUITY, PAYMENT FACTORS, AND DIRECT CARE ON PREDICTED SUPPORT BY PHYSICIANS FOR WELLNESS ACTIVITIES IN SASKATCHEWAN

Abstract

Physicians can anticipate pressure from Saskatchewan health care reform (The Wellness Project) to increase participation in preventive medicine counselling, training (teaching) and research, multi-skilled health teams, and institutional administrative duties. Motivation theory, expectancy theory and equity theory may be used to explain how remuneration and professional objectives influence support for these activities. The purpose of this thesis is to determine the effect of remuneration on wellness activities and how differences in levels of support might be explained by perceptions of equity, importance of payment factors and anticipated levels of direct patient care. This cross sectional study of a111462 physicians actively practising in Saskatchewan during 1991/1992 used survey data originally collected as a one time only observation in 1992 (Lepnurm and Henderson, 1992). Levels of predicted support for wellness activities were compared using the paired t-test and the independent sample test. The relationships between the dependent, independent and control variables were tested using analysis of variance (ANOVA), One-way analysis and the Tukey Test. Physicians predicted more support for wellness activities under salary (0.2836) compared to capitation (-0.7813), and more support under fee-for-service (0.4156) compared to capitation. Support for wellness activities under salary (0.3304) was not found to be greater than support under fee-for-service (0.3699). Support for wellness activities under fee-for-service and salary declined as equity increased, but the importance placed on payment factors did not appear to affect support. Support for wellness activities under fee-for-service increased as the level of direct patient care increased. Most physicians appear to support the objectives of the Wellness Project, but this support will be contingent on a remuneration system that is seen to be equitable for both the physicians and their patients. Some physicians perceiving a high to very high level of equity were prepared to reduce their level of wellness activities if the remuneration system was not seen as supporting performance goals. Capitation, in particular, was viewed by some physicians as a threat in terms of affecting their ability to provide wellness activities regardless of the present method of remuneration.