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PubMed1987

Equal Remuneration (Amendment) Act, 1987 (No. 49 of 1987), 16 December 1987.

This Act amends the Equal Remuneration Act, 1976, specifically to prohibit discrimination between men and women in relation to conditions of service subsequent to employment such as promotions, training, or transfer. The original Act contained no such provisions. Sections of the Act are also amended to provide for greater penalties and for the lodging of complaints by any person aggrieved and by any recognized welfare institution or organization, in addition to government officials.

Asia↗
PubMed1991

Alternative methods of hospital remuneration in Israel.

The current method of remunerating hospitals by an average per diem fee tends to over-reimburse hospitals that have a concentration of departments whose true costs are less than the average price received. Hospitals with a high concentration of expensive high-technology service departments whose true costs are more than the average price received will be under-reimbursed and are obliged to cover their running deficits by other means, e.g., donations. Reimbursements on a per diem basis provide a 'perverse incentive' for all hospitals to maximize the length of patient stays in order to maximize their income. This paper briefly examines alternative methods to the deficient per diem method of reimbursing hospitals, such as fee for service, historical budgeting, capitation, gatekeeper's fees and diagnosis-related groups (DRGs). Fee for service or historical budgeting shows little or no advantage over the present system. However, a combination of capitation and/or DRG linked with some form of payment via physician gatekeepers appears to provide a favorable option for correcting the distortions of the per diem system. Department-specific DRG weights for each hospital's department admission mix are used to estimate the magnitude of the current distortion in resources allocated to hospitals. The calculation is based on the changes in hospital income were a DRG mechanism introduced instead of a per diem method. Such changes would increase the hospitalization income of hospitals with low lengths of stay and high bed turnover rates up to 39%. Regional hospital centers with high lengths of stays and low bed turnover rates would receive as much as 17% lower income in some cases. Only if DRG weights were available for each individual hospital would it be possible to ascertain whether differences in lengths of stay reflect differing severities of case loads or differing hospital efficiency levels.

Capitation Fee↗
PubMed1990

Remuneration, freedom of choice, professional guinea pig.

The law of December 20, 1988 states that a participant in a clinical test without direct therapeutic benefit is not entitled to receive remuneration. Professionalism may be the strongest reason for participating. The law prohibits some participants from receiving an indemnity, not on the basis of healthy vs sick discrimination but when a situation of particular vulnerability or dependence has been established.

France↗
PubMed1989

Part-time women general practitioners--workload and remuneration.

A postal questionnaire survey was conducted comparing the workload and remuneration of part-time women principals in group practices in the Northern and Oxford regions. Part time was defined as receiving less than a full profit share at parity. Of 501 women principals 308 (62%) responded of whom 146 (47%) were part-time. Respondents were asked to record aspects of workload over a four-week period for themselves and their full-time partner who did the most sessions within the practice. The results showed that although two-thirds of the part-timers had 50% or less of a full profit share, part-time principals overall did about 76% of the daytime clinical work (surgeries and home visits) done by their full-time partners, excluding specialized clinics. The lower the profit share the wider this discrepancy. Although 33% of the respondents did not out-of-hours work, the remainder did more than their profit share would indicate. Twenty per cent of the 116 principals with 40% or more of a full profit share and 57% of the 30 principals with less than 40% of a full profit share felt that their share was unfair. Lack of involvement in practice business and feeling that opinions did not carry equal weight were associated with feelings of unfairness.

Female↗
PubMed1996

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.

Capitation Fee↗