• R Dobson and R Lepnurm.
• Institute for Health and Outcomes Research, Department of Physical Medicine and Rehabilitation, Royal University Hospital, Saskatoon, Sask., Canada. rtd124@mail.usask.ca
• Soc Sci Med. 2000 Jan 1; 50 (1): 107-21.

AbstractThe medical model is no longer accepted by many as the best means of achieving optimal health. Financial constraints are pushing more efficient and effective ways to deliver services. In Saskatchewan, greater emphasis is being placed on wellness activities (preventive medical counselling, clinical work with other professionals, training, teaching and research and institutional medical administrative duties). We sought to determine if predicted support for these activities was related to equity of income as perceived by physicians. The study design was a cross-sectional study of all 1462 physicians actively practising in Saskatchewan during 1991/1992. The data were originally collected by Lepnurm and Henderson during the summer of 1992. ANOVA tests were conducted between predicted support for wellness activities and income equity to determine if there were significant interactions. Predicted support for wellness activities was measured by four items: preventive medicine counselling activities during office visits, clinical work with other health professionals, teaching and research, and, institutional medical administrative duties. The first income equity construct was based on: satisfaction with income, fairness of fee-for-service between general practitioners and specialists, fairness of fee-for-service between cognitive and procedural/technical specialists, and the current method of payment reflected factors important to physicians. To increase sample size a second equity construct was created by dropping fairness of fee-for-service between cognitive and procedural/technical specialists. The main effect and significant interactions with control variables were subjected to further analysis using Tukey's test. Significant relationships were found between changes in wellness activities under fee-for-service and income equity (p = 0.001 and p = 0.033) and between changes in wellness activities under salary and income equity (p = 0.002 and p = 0.037). No significant relationships (p = 0.858 and p = 0.610) were found between support for wellness activities under capitation and income equity. The findings of this study demonstrate a relationships between perceived equity of income and predicted support for wellness activities. The authors suggest that these findings were not merely a reflection of the desire by physicians to modify their tasks to accommodate perceived inequity associated with their method of remuneration. Physicians were given the option of considering which method of payment (fee-for-service, salary or capitation) best reflected factors important to them. We suggest that many physicians value wellness activities and would prefer to modify their current patterns of practice, whether they are paid by fee-for-service or by salaried methods.

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