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Doctors at the nation's largest chain of walk-in clinics performed about 20 percent more tests and X-rays after the owners began letting them keep part of the fees their patients paid, a study found.

The study implies that whether or not a sick person receives a test or a procedure can depend on what the doctor makes, rather than strictly what the patient needs.While this conflict of interest may influence care at many levels of medicine, the latest study focused on storefront walk-in clinics, which often pay their doctors a percentage of their patients' total bills.

Some critics contend this system gives doctors a financial incentive to perform more tests and X-rays. If this is the intention, the study suggests that it works: Doctors subjected their patients to more tests and other care when they personally profited from the extra care.

``As in most professions, money matters,' said David Hemenway, an economist at the Harvard School of Public Health who directed the study.

The study compared how 15 doctors changed their practice habits in 1984 and 1985 when their employer switched from paying hourly wages to giving them a cut of the total receipts. It was performed at Health Stop, a Massachusetts-based chain with 80 walk-in centers in six states.

It operates clinics under the Health Stop name in Massachusetts and New Hampshire, under the name Primedical in Georgia, Missouri and North Carolina, and under the name MedFirst in Illinois.

Dr. Mark Shankman, Health Stop's chief executive officer, said the chain's compensation rules have changed substantially since the study was conducted. He said the changes attempt to reward doctors for hard work and good medical practice.

``It's disheartening to me,' he said of the study. ``We work very hard here. That happened five years ago. It has nothing to do with how we operate now.'


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