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Yonder: Payment systems, transgender adolescents, eating disorders, and sexual health knowledge gaps.

Payment systems. Payment systems can purportedly create financial incentives for clinician behaviour that lead to desirable outcomes for healthcare systems, such as cost-efficiency and equity. There is, however, also a risk of unintended consequences of payment systems, such as ‘over-providing’ care. A recent Swedish study examined how managers and salaried doctors at primary healthcare centres perceive that payment incentives affect their work.1 Responders perceived fee-for-service payments to stimulate production of shorter visits, up-coding of visits, and ‘skimming’ of healthier patients. They also felt that riskadjustments for diagnoses led to a focus on registering diagnosis codes, and, to some extent, also up-coding of secondary diagnoses. The authors note that these managers and salaried GPs were attentive to unit-level payment incentives despite not directly benefiting financially themselves.