[Physician payment mechanisms. An instrument of health policy]

Abstract

Payment mechanisms for physicians have always been subject of debate. The profession tends to prefer fee-for-services, while health care institutions prefer to pay doctors by salary or capitation. The definition of the payment mechanism is not an administrative decision, it is frequently the output of an intense political negotiation. Recently an increase in salaried physicians has been observed, even in countries where the profession is powerful. In nations like Mexico, where the State is the dominant actor, salary or capitation can be used as an instrument to encourage quality of care and better geographic distribution. In this paper, several country cases are reviewed.