It is believed widely that the method by which physicians are paid affects their
professional behaviour. In the fee-for-service (FFS) model, physicians are paid a fee for
each unit of care they provide. With target payments, physicians are paid a lump sum
only if a specified target level of service is provided. Under capitation, physicians are
remunerated for each registered patient, to cover the services provided to them.
Salaried physicians receive a lump sum salary for a specified number of work hours.
Payment systems for physicians have been manipulated to attempt to achieve policy
objectives such as improving quality of care, cost containment and recruitment to
underserved areas.
Key messages
 Very low quality evidence suggests that fee-for-service can achieve higher compliance
with recommended frequencies of patient visits. The impact of fee-for-service
on the quantity of primary care services is not well documented and is likely to depend
on fee-for-service rates
 A small study found that salaried primary care professionals may have fewer
scheduled visits and well child visits, and more emergency visits, compared with feefor-
service primary care professionals. However, fee-for-service physicians have more
visits than a recommended schedule
 Evidence on the impact of target payments, compared to fee-for-service, on immunisation
rates is inconclusive
 All of the included studies were from high income countries.