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Ellegård LM, Glenngård AH. Limited Consequences of a Transition From Activity-Based Financing to Budgeting: Four Reasons Why According to Swedish Hospital Managers. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2019; 56:46958019838367. [PMID: 30983464 PMCID: PMC6466459 DOI: 10.1177/0046958019838367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 02/05/2019] [Accepted: 02/21/2019] [Indexed: 11/30/2022]
Abstract
Activity-based financing (ABF) and global budgeting are two common reimbursement models in hospital care that embody different incentives for cost containment and quality. The purpose of this study was to explore and describe perceptions from the provider perspective about how and why replacing variable ABF by global budgets affects daily operations and provided services. The study setting is a large Swedish county council that went from traditional budgeting to an ABF system and then back again in the period 2005-2012. Based on semistructured interviews with midlevel managers and analysis of administrative data, we conclude that the transition back from ABF to budgeting has had limited consequences and suggest 4 reasons why: (1) Midlevel managers dampen effects of changes in the external control; (2) the actual design of the different reimbursement models differed from the textbook design; (3) the purchasing body's use of other management controls did not change; (4) incentives bypassing the purchasing body's controls dampened the consequences. The study highlights the challenges associated with improvement strategies that rely exclusively on budget system changes within traditional tax-funded and politically managed health care systems.
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152
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Weigel TF, Hanisch E, Hanisch A, Buia A, Müller LP, Messias J, Hessler C. Power of Judgment: The Significance of Kant's Philosophy for the Medical System Today. JOURNAL OF SURGICAL EDUCATION 2019; 76:4-8. [PMID: 30111517 DOI: 10.1016/j.jsurg.2018.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 06/17/2018] [Accepted: 07/08/2018] [Indexed: 06/08/2023]
Abstract
The ways of thinking in the manufacturing sciences are increasingly determining the rationality within medicine as a practical or action-based science. This "technological paradigm" infiltrates the field of medicine with the promise of increasing efficiency while simultaneously improving quality at various points in the system. Simple linear causal relationships generally need to be taken into account when manufacturing products. Even complex manufacturing processes can be broken down into the smallest units and, therefore, also be automated. The situation in complex systems such as the human body, however, is completely different. In order for doctors to be able to carry out their actions within this complex system, medicine as a science provides the physician with rules on the means that should be used to decide which remedy should be used, when and how. This judgment of which remedy should be used, when and how, what is known as the indication, is a central medical moment. This requires a power of judgment sharpened by experience. The indication, in turn, essentially determines the course of a disease and thus the quality of the treatment or the quality of result so often referred to these days.
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Affiliation(s)
- T F Weigel
- Department of General- and Visceral Surgery, Heilig-Geist-Hospital, Bingen, Germany.
| | - E Hanisch
- Department of Visceral- and Thoracic Surgery, Asklepios Klinik, Langen, Germany
| | - A Hanisch
- KfW Development Bank, Frankfurt, Germany
| | - A Buia
- Department of Visceral- and Thoracic Surgery, Asklepios Klinik, Langen, Germany
| | - L P Müller
- Department of Trauma and Orthopaedic Surgery, University of Cologne, Cologne, Germany
| | - J Messias
- Department of General- and Visceral Surgery, Heilig-Geist-Hospital, Bingen, Germany
| | - C Hessler
- Department of General- and Visceral Surgery, Heilig-Geist-Hospital, Bingen, Germany
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153
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Major concerns remain around pay-for-performance programs in Canada. Can Pharm J (Ott) 2019; 152:54-55. [DOI: 10.1177/1715163518816666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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154
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Lewis CC, Boyd M, Puspitasari A, Navarro E, Howard J, Kassab H, Hoffman M, Scott K, Lyon A, Douglas S, Simon G, Kroenke K. Implementing Measurement-Based Care in Behavioral Health: A Review. JAMA Psychiatry 2018; 76:324-335. [PMID: 30566197 PMCID: PMC6584602 DOI: 10.1001/jamapsychiatry.2018.3329] [Citation(s) in RCA: 264] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE Measurement-based care (MBC) is the systematic evaluation of patient symptoms before or during an encounter to inform behavioral health treatment. Despite MBC's demonstrated ability to enhance usual care by expediting improvements and rapidly detecting patients whose health would otherwise deteriorate, it is underused, with typically less than 20% of behavioral health practitioners integrating it into their practice. This narrative review addresses definitional issues, offers a concrete and evaluable operationalization of MBC fidelity, and summarizes the evidence base and utility of MBC. It also synthesizes the extant literature's characterization of barriers to and strategies for supporting MBC implementation, sustainment, and scale-up. OBSERVATIONS Barriers to implementing MBC occur at multiple levels: patient (eg, concerns about confidentiality breach), practitioner (eg, beliefs that measures are no better than clinical judgment), organization (eg, no resources for training), and system (eg, competing requirements). Implementation science-the study of methods to integrate evidence-based practices such as MBC into routine care-offers strategies to address barriers. These strategies include using measurement feedback systems, leveraging local champions, forming learning collaboratives, training leadership, improving expert consultation with clinical staff, and generating incentives. CONCLUSIONS AND RELEVANCE This narrative review, informed by implementation science, offers a 10-point research agenda to improve the integration of MBC into clinical practice: (1) harmonize terminology and specify MBC's core components; (2) develop criterion standard methods for monitoring fidelity and reporting quality of implementation; (3) develop algorithms for MBC to guide psychotherapy; (4) test putative mechanisms of change, particularly for psychotherapy; (5) develop brief and psychometrically strong measures for use in combination; (6) assess the critical timing of administration needed to optimize patient outcomes; (7) streamline measurement feedback systems to include only key ingredients and enhance electronic health record interoperability; (8) identify discrete strategies to support implementation; (9) make evidence-based policy decisions; and (10) align reimbursement structures.
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Affiliation(s)
- Cara C. Lewis
- Kaiser Permanente Washington Health Research Institute,
Seattle
| | - Meredith Boyd
- Department of Psychology, UCLA (University of California, Los
Angeles)
| | - Ajeng Puspitasari
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester,
Minnesota
| | - Elena Navarro
- Kaiser Permanente Washington Health Research Institute,
Seattle
| | - Jacqueline Howard
- Department of Psychological and Brain Sciences, Indiana University,
Bloomington
| | | | - Mira Hoffman
- Department of Psychology, West Virginia University,
Morgantown
| | - Kelli Scott
- School of Public Health, Brown University, Providence, Rhode
Island
| | - Aaron Lyon
- Department of Psychiatry and Behavioral Sciences, University of
Washington, Seattle
| | - Susan Douglas
- Department of Leadership, Policy and Organizations, Peabody
College, Vanderbilt University, Nashville, Tennessee
| | - Greg Simon
- Kaiser Permanente Washington Health Research Institute,
Seattle
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155
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Affiliation(s)
- M Ruth Lavergne
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC
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156
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Allen T, Whittaker W, Kontopantelis E, Sutton M. Influence of financial and reputational incentives on primary care performance: a longitudinal study. Br J Gen Pract 2018; 68:e811-e818. [PMID: 30397016 PMCID: PMC6255225 DOI: 10.3399/bjgp18x699797] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/25/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The Quality and Outcomes Framework has generated reputational as well as financial rewards for general practices because the number of quality points a practice receives is publicly reported. These rewards vary across diseases and practices, and over time. AIM To determine the relative effects on performance of the financial and reputational rewards resulting from a pay-for-performance programme. DESIGN AND SETTING Observational study of the published performance on 42 indicators of 8929 practices in England between 2004 and 2013. METHOD The authors calculated the revenue offered (financial reward, measured in £100s) and the points offered (reputational reward) per additional patient treated for each indicator for each practice in each year. Fixed-effects multivariable regression models were used to estimate whether the percentage of eligible patients treated responded to changes in these financial and reputational rewards. RESULTS Both the offered financial rewards and reputational rewards had small but statistically significant associations with practice performance. The effect of the financial reward on performance decreased from 0.797 percentage points per £100 (95% confidence interval [CI] = 0.614 to 0.979) in 2004, to 0.092 (95% CI = 0.045 to 0.138) in 2013. The effect of the reputational reward increased from -0.121 percentage points per quality point (95% CI = -0.220 to -0.022) in 2004, to 0.209 (95% CI = 0.147 to 0.271) in 2013. CONCLUSION In the short term, general practices were more sensitive to revenue than reputational rewards. In the long term, general practices appeared to divert their focus towards the reputational reward, once benchmarks of performance became established.
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Affiliation(s)
| | | | | | - Matt Sutton
- School of Health Sciences, University of Manchester, Manchester
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157
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Ride J, Kasteridis P, Gutacker N, Kronenberg C, Doran T, Mason A, Rice N, Gravelle H, Goddard M, Kendrick T, Siddiqi N, Gilbody S, Dare CRJ, Aylott L, Williams R, Jacobs R. Do care plans and annual reviews of physical health influence unplanned hospital utilisation for people with serious mental illness? Analysis of linked longitudinal primary and secondary healthcare records in England. BMJ Open 2018; 8:e023135. [PMID: 30498040 PMCID: PMC6278786 DOI: 10.1136/bmjopen-2018-023135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate whether two primary care activities that are framed as indicators of primary care quality (comprehensive care plans and annual reviews of physical health) influence unplanned utilisation of hospital services for people with serious mental illness (SMI). DESIGN, SETTING, PARTICIPANTS Retrospective observational cohort study using linked primary care and hospital records (Hospital Episode Statistics) for 5158 patients diagnosed with SMI between April 2006 and March 2014, who attended 213 primary care practices in England that contribute to the Clinical Practice Research Datalink GOLD database. OUTCOMES AND ANALYSIS Cox survival models were used to estimate the associations between two primary care quality indicators (care plans and annual reviews of physical health) and the hazards of three types of unplanned hospital utilisation: presentation to accident and emergency departments (A&E), admission for SMI and admission for ambulatory care sensitive conditions (ACSC). RESULTS Risk of A&E presentation was 13% lower (HR 0.87, 95% CI 0.77 to 0.98) and risk of admission to hospital for ACSC was 23% lower (HR 0.77, 95% CI 0.60 to 0.99) for patients with a care plan documented in the previous year compared with those without a care plan. Risk of A&E presentation was 19% lower for those who had a care plan documented earlier but not updated in the previous year (HR: 0.81, 95% CI 0.67 to 0.97) compared with those without a care plan. Risks of hospital admission for SMI were not associated with care plans, and none of the outcomes were associated with annual reviews. CONCLUSIONS Care plans documented in primary care for people with SMI are associated with reduced risk of A&E attendance and reduced risk of unplanned admission to hospital for physical health problems, but not with risk of admission for mental health problems. Annual reviews of physical health are not associated with risk of unplanned hospital utilisation.
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Affiliation(s)
- Jemimah Ride
- Centre for Health Economics, University of York, York, UK
| | | | - Nils Gutacker
- Centre for Health Economics, University of York, York, UK
| | - Christoph Kronenberg
- CINCH, University Duisburg-Essen, Essen, Germany
- Leibniz Science Campus Ruhr, Essen, Germany
- RWI – Leibniz-Institute for Economic Research, Essen, Germany
| | - Tim Doran
- Department of Health Sciences, The University of York, York, UK
| | - Anne Mason
- Centre for Health Economics, University of York, York, UK
| | - Nigel Rice
- Centre for Health Economics, University of York, York, UK
| | - Hugh Gravelle
- Centre for Health Economics, University of York, York, UK
| | - Maria Goddard
- Centre for Health Economics, University of York, York, UK
| | - Tony Kendrick
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Najma Siddiqi
- Department of Health Sciences, The University of York, York, UK
| | - Simon Gilbody
- Department of Health Sciences, The University of York, York, UK
| | | | | | | | - Rowena Jacobs
- Centre for Health Economics, University of York, York, UK
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158
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Tsai YS, Kung PT, Ku MC, Wang YH, Tsai WC. Effects of pay for performance on risk incidence of infection and of revision after total knee arthroplasty in type 2 diabetic patients: A nationwide matched cohort study. PLoS One 2018; 13:e0206797. [PMID: 30388167 PMCID: PMC6214551 DOI: 10.1371/journal.pone.0206797] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 10/19/2018] [Indexed: 12/31/2022] Open
Abstract
As the world's population ages, the number of people receiving total knee arthroplasty (TKA) has been on the rise. Although patients with diabetes mellitus are known to face greater risks of TKA postoperative infection and revision TKA owing to diabetic complications, studies on whether such patients' participation in pay for performance (P4P) programs influences the incidence rates of TKA postoperative infection or revision TKA are still lacking. This study examined the 2002-2012 data of Taiwan's National Health Insurance Research Database to conduct a retrospective cohort analysis of diabetic patients over 50 years old who have received TKA. To reduce any selection bias between patients joining and not joining the P4P program, propensity score matching was applied. The Cox proportional hazards model was used to examine the influence of the P4P program on TKA postoperative infection and revision TKA, and the results indicate that joining P4P lowered the risk of postoperative infection (HR = 0.91, 95% CI: 0.77-1.08), however, which was not statistically significant, and significantly lowered the risk of revision TKA (HR = 0.53, 95% CI: 0.39-0.72). Being younger and male, having multiple comorbid conditions or greater diabetic severity, receiving care at regional or public hospitals, and not having a diagnosis of degenerative or rheumatoid arthritis were identified as factors for higher risk of TKA postoperative infection for patients with diabetes. As for the risk of revision TKA, postoperative infection and being younger were identified as factors for a significantly higher risk (p < 0.05).
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Affiliation(s)
- Yi-Shiun Tsai
- Department of Orthopedics, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan, ROC
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C
| | - Ming-Chou Ku
- Department of Orthopedics, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan, ROC
| | - Yeuh-Hsin Wang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
- * E-mail:
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159
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Incentives in a public addiction treatment system: Effects on waiting time and selection. J Subst Abuse Treat 2018; 95:1-8. [PMID: 30352665 DOI: 10.1016/j.jsat.2018.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 09/04/2018] [Accepted: 09/06/2018] [Indexed: 11/21/2022]
Abstract
Program-level financial incentives are used by some payers as a tool to improve quality of substance use treatment. However, evidence of effectiveness is mixed and performance contracts may have unintended consequences such as creating barriers for more challenging clients who are less likely to meet benchmarks. This study investigates the impact of a performance contract on waiting time for substance use treatment and client selection. Admission and discharge data from publicly funded Maine outpatient (OP) and intensive outpatient (IOP) substance use treatment programs (N = 38,932 clients) were used. In a quasi-experimental pre-post design, pre-period (FY 2005-2007) admission data from incentivized (IC) and non-incentivized (non-IC) programs were compared to post-period (FY 2008-2012) using propensity score matching and multivariate difference-in-difference regression. Dependent variables were waiting time (incentivized) and client selection (severity: history of mental disorders and substance use severity, not incentivized). Despite financial incentives designed to reduce waiting time for substance use treatment among state-funded outpatient programs, average waiting time for treatment increased in the post period for both IC and non-IC groups, as did client severity. There were no significant differences in waiting time between IC and non-IC groups over time. Increases in client severity over time, with no group differences, indicate that programs did not restrict access for more challenging clients. Adequate funding and other approaches to improve quality may be beneficial.
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160
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Dohmen PJG, van Raaij EM. A new approach to preferred provider selection in health care. Health Policy 2018; 123:300-305. [PMID: 30249448 DOI: 10.1016/j.healthpol.2018.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 08/24/2018] [Accepted: 09/08/2018] [Indexed: 11/16/2022]
Abstract
In January 2015 Zilveren Kruis, the largest health insurer in The Netherlands, engaged in a new three-year, unlimited volume contract with five carefully selected providers of cataract surgery. Zilveren Kruis used a novel method, designed to identify the top expert providers in a certain discipline. This procedure for provider selection uses the principles of Best Value Procurement (BVP), and puts the provider in charge of defining key performance indicators for health care quality. The procedure empowers the professional and acknowledges that the provider, not the purchaser, is the true expert in defining what is high quality care. This new approach focuses purely on provider selection and is thus complementary to innovations in health care reimbursement, such as value-based hospital purchasing or outcome-based financing. We describe this novel approach to preferred provider selection and show how it makes affordable quality the core topic in negotiations with providers.
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Affiliation(s)
- Peter J G Dohmen
- Rotterdam School of Management, Erasmus University, Burgemeester Oudlaan 50, 3062 PA Rotterdam, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University, Burgemeester Oudlaan 50, 3062 PA Rotterdam, the Netherlands.
| | - Erik M van Raaij
- Rotterdam School of Management, Erasmus University, Burgemeester Oudlaan 50, 3062 PA Rotterdam, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University, Burgemeester Oudlaan 50, 3062 PA Rotterdam, the Netherlands.
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161
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Haarsager J, Krishnasamy R, Gray NA. Impact of pay for performance on access at first dialysis in Queensland. Nephrology (Carlton) 2018; 23:469-475. [PMID: 28240802 DOI: 10.1111/nep.13037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/21/2017] [Accepted: 02/22/2017] [Indexed: 11/27/2022]
Abstract
AIM Commencement of haemodialysis with an arteriovenous fistula (AVF) or arteriovenous graft (AVG) is associated with improved survival compared with commencement with a central venous catheter. In 2011-2012, Queensland Health made incentive payments to renal units for early referred patients who commenced peritoneal dialysis (PD), or haemodialysis with an AVF/AVG. The aim of this study was to determine if pay for performance improved clinical care. METHODS All patients who commenced dialysis in Australia between 2009 and 2014 and were registered with the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) were included. A multivariable regression model was used to compare rates of commencing dialysis with a PD catheter or permanent AVF/AVG during the pay-for-performance period (2011-2012) with periods prior (2009-2010) and after (2013-2014). RESULTS A total of 10 858 early referred patients commenced dialysis during the study period, including 2058 in Queensland. In Queensland, PD as first modality increased with time (P < 0.001) but there was no change in AVF/AVG rate at first haemodialysis (P = 0.5). In a multivariate model using the pay-for-performance period as reference, the odds ratio for commencement with PD or haemodialysis with an AVF/AVG in Queensland was 1.02 (95% CI 0.81-1.29) in 2009-2010 and 1.28 (95% CI 1.01-1.61) in 2013-2014. There was no change for the rest of Australia (0.97 95% CI 0.87-1.09 in 2009-2010 and 1.00 95% CI 0.90-1.11 in 2013-14). CONCLUSION Pay for performance did not improve rates of commencement of dialysis with PD or an AVF/AVG during the payment period. A lag effect on clinical care may explain the improvement in later years.
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Affiliation(s)
- Jennie Haarsager
- Department of Nephrology, Nambour General Hospital, Nambour, Queensland, Australia
| | - Rathika Krishnasamy
- Department of Nephrology, Nambour General Hospital, Nambour, Queensland, Australia.,Sunshine Coast Clinical School, Nambour General Hospital, The University of Queensland, Nambour, Queensland, Australia.,Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia
| | - Nicholas A Gray
- Department of Nephrology, Nambour General Hospital, Nambour, Queensland, Australia.,Sunshine Coast Clinical School, Nambour General Hospital, The University of Queensland, Nambour, Queensland, Australia.,Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia
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162
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Rudasingwa M, Uwizeye MR. Physicians' and nurses' attitudes towards performance-based financial incentives in Burundi: a qualitative study in the province of Gitega. Glob Health Action 2018; 10:1270813. [PMID: 28452651 PMCID: PMC5328346 DOI: 10.1080/16549716.2017.1270813] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Performance-based financing (PBF) was first implemented in Burundi in 2006 as a pilot programme in three provinces and was rolled out nationwide in 2010. PBF is a reform approach to improve the quality, quantity, and equity of health services and aims at achieving universal health coverage. It focuses on how to best motivate health practitioners. Objective: To elicit physicians’ and nurses’ experiences and views on how PBF influenced and helped them in healthcare delivery. Methods: A qualitative cross-sectional study was carried out among frontline health workers such as physicians and nurses. The data was gathered through individual face-to-face, in-depth, semi-structured interviews with 6 physicians and 30 nurses from February to March 2011 in three hospitals in Gitega Province. A simple framework approach and thematic analysis using a combination of manual technique and MAXQDA software guided the analysis of the interview data. Results: Overall, the interviewees felt that the PBF scheme had provided positive motivation to improve the quality of care, mainly in the structures and process of care. The utilization of health services and the relationship between health practitioners and patients also improved. The salary top-ups were recognized as the most significant impetus to increase effort in improving the quality of care. The small and sometimes delayed financial incentives paid to physicians and nurses were criticized. The findings of this study also indicate that the positive interaction between performance-based incentive schemes and other health policies is crucial in achieving comprehensive improvement in healthcare delivery. Conclusions: PBF has the potential to motivate medical staff to improve healthcare provision. The views of medical staff and the context of the area of implementation have to be taken into consideration when designing and implementing PBF schemes.
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Affiliation(s)
- Martin Rudasingwa
- a Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne, Faculty of Medicine , University of Cologne , Cologne , Germany
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163
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164
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Minchin M, Roland M, Richardson J, Rowark S, Guthrie B. Quality of Care in the United Kingdom after Removal of Financial Incentives. N Engl J Med 2018; 379:948-957. [PMID: 30184445 DOI: 10.1056/nejmsa1801495] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The benefits of pay-for-performance schemes in improving the quality of care remain uncertain. There is little information on the effect of removing incentives from existing pay-for-performance schemes. METHODS We conducted interrupted time-series analyses of electronic medical record (EMR) data from 2010 to 2017 for 12 quality-of-care indicators in the United Kingdom's Quality and Outcomes Framework for which financial incentives were removed in 2014 and 6 indicators for which incentives were maintained. We estimated the effects of removing incentives on changes in performance on quality-of-care measures. RESULTS Complete longitudinal data were available for 2819 English primary care practices with more than 20 million registered patients. There were immediate reductions in documented quality of care for all 12 indicators in the first year after the removal of financial incentives. Reductions were greatest for indicators related to health advice, with a reduction of 62.3 percentage points (95% confidence interval [CI], -65.6 to -59.0) in EMR documentation of lifestyle counseling for patients with hypertension. Changes were smaller for indicators involving clinical actions that automatically update the EMR, such as laboratory testing, with a reduction of 10.7 percentage points (95% CI, -13.6 to -7.8) in control of cholesterol in patients with coronary heart disease and 12.1 percentage points (95% CI, -13.6 to -10.6) for thyroid-function testing in patients with hypothyroidism. There was little change in performance on the 6 quality measures for which incentives were maintained. CONCLUSIONS Removal of financial incentives was associated with an immediate decline in performance on quality measures. In part, the decline probably reflected changes in EMR documentation, but declines on measures involving laboratory testing suggest that incentive removal also changed the care delivered.
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Affiliation(s)
- Mark Minchin
- From the National Institute for Health and Care Excellence (NICE), Manchester (M.M., J.R., S.R.), the Department of Public Health and Primary Care, University of Cambridge, Cambridge (M.R.), and the Population Health and Genomics Division, University of Dundee, Dundee (B.G.) - all in the United Kingdom
| | - Martin Roland
- From the National Institute for Health and Care Excellence (NICE), Manchester (M.M., J.R., S.R.), the Department of Public Health and Primary Care, University of Cambridge, Cambridge (M.R.), and the Population Health and Genomics Division, University of Dundee, Dundee (B.G.) - all in the United Kingdom
| | - Judith Richardson
- From the National Institute for Health and Care Excellence (NICE), Manchester (M.M., J.R., S.R.), the Department of Public Health and Primary Care, University of Cambridge, Cambridge (M.R.), and the Population Health and Genomics Division, University of Dundee, Dundee (B.G.) - all in the United Kingdom
| | - Shaun Rowark
- From the National Institute for Health and Care Excellence (NICE), Manchester (M.M., J.R., S.R.), the Department of Public Health and Primary Care, University of Cambridge, Cambridge (M.R.), and the Population Health and Genomics Division, University of Dundee, Dundee (B.G.) - all in the United Kingdom
| | - Bruce Guthrie
- From the National Institute for Health and Care Excellence (NICE), Manchester (M.M., J.R., S.R.), the Department of Public Health and Primary Care, University of Cambridge, Cambridge (M.R.), and the Population Health and Genomics Division, University of Dundee, Dundee (B.G.) - all in the United Kingdom
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165
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Pandya A, Doran T, Zhu J, Walker S, Arntson E, Ryan AM. Modelling the cost-effectiveness of pay-for-performance in primary care in the UK. BMC Med 2018; 16:135. [PMID: 30153827 PMCID: PMC6114231 DOI: 10.1186/s12916-018-1126-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 07/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Introduced in 2004, the United Kingdom's (UK) Quality and Outcomes Framework (QOF) is the world's largest primary-care pay-for-performance programme. Given some evidence of the benefits and the substantial costs associated with the QOF, it remains unclear whether the programme is cost-effective. Therefore, we assessed the cost-effectiveness of continuing versus stopping the QOF. METHODS We developed a lifetime simulation model to estimate quality-adjusted life years (QALYs) and costs for a UK population cohort aged 40-74 years (n = 27,070,862) exposed to the QOF and for a counterfactual scenario without exposure. Based on a previous retrospective cross-country analysis using data from 1994 to 2010, we assumed the benefits of the QOF to be a change in age-adjusted mortality of -3.68 per 100,000 population (95% confidence interval -8.16 to 0.80). We used cost-effectiveness thresholds of £30,000/QALY, £20,000/QALY and £13,000/QALY to determine the optimal strategy in base-case and sensitivity analyses. RESULTS In the base-case analysis, continuing the QOF increased population-level QALYs and health-care costs yielding an incremental cost-effectiveness ratio (ICER) of £49,362/QALY. The ICER remained >£30,000/QALY in scenarios with and without non-fatal outcomes or increased drug costs, and under differing assumptions about the duration of QOF benefit following its hypothetical discontinuation. The ICER for continuing the programme fell below £30,000/QALY when QOF incentive payments were 36% lower (while preserving QOF mortality benefits), and in scenarios where the QOF resulted in substantial reductions in health-care spending or non-fatal cardiovascular disease events. Continuing the QOF was cost-effective in 18%, 3% and 0% of probabilistic sensitivity analysis iterations using thresholds of £30,000/QALY, £20,000/QALY and £13,000/QALY, respectively. CONCLUSIONS Compared to stopping the QOF and returning all associated incentive payments to the National Health Service, continuing the QOF is not cost-effective. To improve population health efficiently, the UK should redesign the QOF or pursue alternative interventions.
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Affiliation(s)
- Ankur Pandya
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, 2nd Floor, Boston, MA, 02115, USA. .,Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Tim Doran
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Jinyi Zhu
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Simon Walker
- Centre for Health Economics, University of York, Heslington, York, UK
| | - Emily Arntson
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Andrew M Ryan
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
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166
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Affiliation(s)
- Stephan D Fihn
- Department of Medicine, University of Washington, Seattle
- Department of Health Services, University of Washington, Seattle
- Deputy Editor, , Chicago, Illinois
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167
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Garner BR, Lwin AK, Strickler GK, Hunter BD, Shepard DS. Pay-for-performance as a cost-effective implementation strategy: results from a cluster randomized trial. Implement Sci 2018; 13:92. [PMID: 29973280 PMCID: PMC6033288 DOI: 10.1186/s13012-018-0774-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 05/31/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Pay-for-performance (P4P) has been recommended as a promising strategy to improve implementation of high-quality care. This study examined the incremental cost-effectiveness of a P4P strategy found to be highly effective in improving the implementation and effectiveness of the Adolescent Community Reinforcement Approach (A-CRA), an evidence-based treatment (EBT) for adolescent substance use disorders (SUDs). METHODS Building on a $30 million national initiative to implement A-CRA in SUD treatment settings, urn randomization was used to assign 29 organizations and their 105 therapists and 1173 patients to one of two conditions (implementation-as-usual (IAU) control condition or IAU+P4P experimental condition). It was not possible to blind organizations, therapists, or all research staff to condition assignment. All treatment organizations and their therapists received a multifaceted implementation strategy. In addition to those IAU strategies, therapists in the IAU+P4P condition received US $50 for each month that they demonstrated competence in treatment delivery (A-CRA competence) and US $200 for each patient who received a specified number of treatment procedures and sessions found to be associated with significantly improved patient outcomes (target A-CRA). Incremental cost-effectiveness ratios (ICERs), which represent the difference between the two conditions in average cost per treatment organization divided by the corresponding average difference in effectiveness per organization, and quality-adjusted life years (QALYs) were the primary outcomes. RESULTS At trial completion, 15 organizations were randomized to the IAU condition and 14 organizations were randomized to the IAU+P4P condition. Data from all 29 organizations were analyzed. Cluster-level analyses suggested the P4P strategy led to significantly higher average total costs compared to the IAU control condition, yet this average increase of 5% resulted in a 116% increase in the average number of months therapists demonstrated competence in treatment delivery (ICER = $333), a 325% increase in the average number of patients who received the targeted dosage of treatment (ICER = $453), and a 325% increase in the number of days of abstinence per patient in treatment (ICER = $8.134). Further supporting P4P as a cost-effective implementation strategy, the cost per QALY was only $8681 (95% confidence interval $1191-$16,171). CONCLUSION This study provides experimental evidence supporting P4P as a cost-effective implementation strategy. TRIAL REGISTRATION NCT01016704 .
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Affiliation(s)
- Bryan R. Garner
- RTI International, P. O. Box 12194, Research Triangle Park, Raleigh, NC 27709-2194 USA
| | - Aung K. Lwin
- Schneider Institutes for Health Policy, The Heller School, MS035, Brandeis University, Waltham, MA USA
| | - Gail K. Strickler
- Schneider Institutes for Health Policy, The Heller School, MS035, Brandeis University, Waltham, MA USA
| | | | - Donald S. Shepard
- Schneider Institutes for Health Policy, The Heller School, MS035, Brandeis University, Waltham, MA USA
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Burau V, Dahl HM, Jensen LG, Lou S. Beyond Activity Based Funding. An experiment in Denmark. Health Policy 2018; 122:714-721. [DOI: 10.1016/j.healthpol.2018.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 04/13/2018] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
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169
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Paul E, Fecher F, Meloni R, van Lerberghe W. Universal Health Coverage in Francophone Sub-Saharan Africa: Assessment of Global Health Experts' Confidence in Policy Options. GLOBAL HEALTH, SCIENCE AND PRACTICE 2018; 6:260-271. [PMID: 29844097 PMCID: PMC6024618 DOI: 10.9745/ghsp-d-18-00001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/29/2018] [Indexed: 11/15/2022]
Abstract
Many countries rely on standard recipes for accelerating progress toward universal health coverage (UHC). With limited generalizable empirical evidence, expert confidence and consensus plays a major role in shaping country policy choices. This article presents an exploratory attempt conducted between April and September 2016 to measure confidence and consensus among a panel of global health experts in terms of the effectiveness and feasibility of a number of policy options commonly proposed for achieving UHC in low- and middle-income countries, such as fee exemptions for certain groups of people, ring-fenced domestic health budgets, and public-private partnerships. To ensure a relative homogeneity of contexts, we focused on French-speaking sub-Saharan Africa. We initially used the Delphi method to arrive at expert consensus, but since no consensus emerged after 2 rounds, we adjusted our approach to a statistical analysis of the results from our questionnaire by measuring the degree of consensus on each policy option through 100 (signifying total consensus) minus the size of the interquartile range of the individual scores. Seventeen global health experts from various backgrounds, but with at least 20 years' experience in the broad region, participated in the 2 rounds of the study. The results provide an initial "mapping" of the opinions of a group of experts and suggest interesting lessons. For the 18 policy options proposed, consensus emerged only on strengthening the supply of quality primary health care services (judged as being effective with a confidence score of 79 and consensus score of 90), and on fee exemptions for the poorest (judged as being fairly easy to implement with a confidence score of 66 and consensus score of 85). For none of the 18 common policy options was there consensus on both potential effectiveness and feasibility, with very diverging opinions concerning 5 policy options. The lack of confidence and consensus within the panel seems to reflect the lack of consistent evidence on the proposed policy options. This suggests that experts' opinions should be framed within strengthened inclusive and "evidence-informed deliberative processes" where the trade-offs along the 3 dimensions of UHC-extending the population covered against health hazards, expanding the range of services and benefits covered, and reducing out-of-pocket expenditures-can be discussed in a transparent and contextualized setting.
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Affiliation(s)
- Elisabeth Paul
- Political Economy and Health Economics, Faculty of Social Sciences, Université de Liège, Liège, Belgium.
- School of Public Health, Université libre de Bruxelles, Brussels, Belgium
| | - Fabienne Fecher
- Political Economy and Health Economics, Faculty of Social Sciences, Université de Liège, Liège, Belgium
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170
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Borghi J, Singh NS, Brown G, Anselmi L, Kristensen S. Understanding for whom, why and in what circumstances payment for performance works in low and middle income countries: protocol for a realist review. BMJ Glob Health 2018; 3:e000695. [PMID: 29988988 PMCID: PMC6035508 DOI: 10.1136/bmjgh-2017-000695] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 05/03/2018] [Accepted: 05/17/2018] [Indexed: 12/22/2022] Open
Abstract
Background Many low and middle income countries (LMIC) are implementing payment for performance (P4P) schemes to strengthen health systems and make progress towards universal health coverage. A number of systematic reviews have considered P4P effectiveness but did not explore how P4P works in different settings to improve outcomes or shed light on pathways or mechanisms of programme effect. This research will undertake a realist review to investigate how, why and in what circumstances P4P leads to intended and unintended outcomes in LMIC. Methods Our search was guided by an initial programme theory of mechanisms and involved a systematic search of Medline, Embase, Popline, Business Source Premier, Emerald Insight and EconLit databases for studies on P4P and health in LMIC. Inclusion and exclusion criteria identify literature that is relevant to the initial programme theory and the research questions underpinning the review. Retained evidence will be used to test, revise or refine the programme theory and identify knowledge gaps. The evidence will be interrogated by examining the relationship between context, mechanisms and intended and unintended outcomes to establish what works for who, in which contexts and why. Discussion By synthesising current knowledge on how P4P affects health systems to produce outcomes in different contexts and to what extent the programme design affects this, we will inform more effective P4P programmes to strengthen health systems and achieve sustainable service delivery and health impacts.
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Affiliation(s)
- Josephine Borghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Neha S Singh
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Garrett Brown
- School of Politics and International Studies, University of Leeds, Leeds, UK
| | - Laura Anselmi
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Soren Kristensen
- Faculty of Medicine, Institute of Global Health Innovation, Centre for Health Policy, Imperial College, London, UK
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171
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Hsieh HM, Chiu HC, Lin YT, Shin SJ. A diabetes pay-for-performance program and the competing causes of death among cancer survivors with type 2 diabetes in Taiwan. Int J Qual Health Care 2018; 29:512-520. [PMID: 28531317 DOI: 10.1093/intqhc/mzx057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 05/06/2017] [Indexed: 12/19/2022] Open
Abstract
Objective To examine associations between a diabetes pay-for-performance (P4P) program in Taiwan and all-cause of mortality and competing causes of death in cancer survivors with type 2 diabetes. Design A longitudinal observational intervention and comparison group study design. Setting and participants Cancer survivors with type 2 diabetes who enrolled in the P4P program compared with survivors who did not participate (non-P4P) under the Taiwan National Health Insurance program. Intervention(s) A nationwide diabetes P4P program. Main outcome measures The main outcome was a comparison of all-cause, diabetes-related and cancer mortality in P4P and non-P4P patients during a 5-year follow-up period. Total person-years and mortality rates per 1000 person-years for causes of death were calculated. Multivariate Cox proportional hazard models and competing risk regression were used in the analysis. Results Overall, our results indicate that P4P cancer survivors had lower risk of all-cause mortality and diabetes-related mortality than non-P4P survivors. Specifically, the hazard ratio (95% confidence interval) was 0.581 (0.447-0.756) for all-cause mortality; SHRs were 0.451 (0.266-0.765) for diabetes-related mortality and 0.791 (0.558-1.121) for cancer mortality. Conclusions Our empirical findings provide evidence of potential benefits of diabetes P4P programs in reducing risks of deaths due to diabetes or cardiovascular diseases among cancer survivors, compared with survivors who did not enroll in the P4P program. In consideration of recommended care for long-term survival, the diabetes P4P program can serve as a care model for cancer survivors for reducing mortality due to diabetes or cardiovascular diseases.
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Affiliation(s)
- Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan.,Department of Community Medicine, Kaohsiung Medical University Hospital, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan
| | - Herng-Chia Chiu
- Research Education and Epidemiology Center, Changhua Christian Hospital, 135 Nan-Hsiao St., Changhua City 50006, Taiwan.,Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan
| | - Yi-Ting Lin
- Division of Family Medicine, Kaohsiung Medical University Hospital, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan
| | - Shyi-Jang Shin
- Graduate Institute of Medical Genetics, College of Medicine, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan.,Division of Endocrinology and Metabolism, Kaohsiung Medical University Hospital, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan
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172
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Herbst T, Foerster J, Emmert M. The impact of pay-for-performance on the quality of care in ophthalmology: Empirical evidence from Germany. Health Policy 2018; 122:667-673. [DOI: 10.1016/j.healthpol.2018.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 01/04/2018] [Accepted: 03/14/2018] [Indexed: 11/29/2022]
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173
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Korlén S, Essén A, Lindgren P, Amer-Wahlin I, von Thiele Schwarz U. Managerial strategies to make incentives meaningful and motivating. J Health Organ Manag 2018; 31:126-141. [PMID: 28482774 PMCID: PMC5868553 DOI: 10.1108/jhom-06-2016-0122] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Purpose Policy makers are applying market-inspired competition and financial incentives to drive efficiency in healthcare. However, a lack of knowledge exists about the process whereby incentives are filtered through organizations to influence staff motivation, and the key role of managers is often overlooked. The purpose of this paper is to explore the strategies managers use as intermediaries between financial incentives and the individual motivation of staff. The authors use empirical data from a local case in Swedish specialized care. Design/methodology/approach The authors conducted an exploratory qualitative case study of a patient-choice reform, including financial incentives, in specialized orthopedics in Sweden. In total, 17 interviews were conducted with professionals in managerial positions, representing six healthcare providers. A hypo-deductive, thematic approach was used to analyze the data. Findings The results show that managers applied alignment strategies to make the incentive model motivating for staff. The managers’ strategies are characterized by attempts to align external rewards with professional values based on their contextual and practical knowledge. Managers occasionally overruled the financial logic of the model to safeguard patient needs and expressed an interest in having a closer dialogue with policy makers about improvements. Originality/value Externally imposed incentives do not automatically motivate healthcare staff. Managers in healthcare play key roles as intermediaries by aligning external rewards with professional values. Managers’ multiple perspectives on healthcare practices and professional culture can also be utilized to improve policy and as a source of knowledge in partnership with policy makers.
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Affiliation(s)
- Sara Korlén
- Medical Management Centre, LIME, Karolinska Institute , Stockholm, Sweden
| | - Anna Essén
- Center for Human Resource Management and Knowledge Work, Stockholm School of Economics, Stockholm, Sweden
| | - Peter Lindgren
- Medical Management Centre, LIME, Karolinska Institute , Stockholm, Sweden.,The Swedish Institute for Health Economics , Stockholm, Sweden
| | - Isis Amer-Wahlin
- Medical Management Centre, LIME, Karolinska Institute , Stockholm, Sweden
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Vainieri M, Lungu DA, Nuti S. Insights on the effectiveness of reward schemes from 10-year longitudinal case studies in 2 Italian regions. Int J Health Plann Manage 2018; 33:e474-e484. [PMID: 29380905 PMCID: PMC6032864 DOI: 10.1002/hpm.2496] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Pay for performance (P4P) programs have been widely analysed in literature, and the results regarding their impact on performance are mixed. Moreover, in the real-life setting, reward schemes are designed combining multiple elements altogether, yet, it is not clear what happens when they are applied using different combinations. OBJECTIVES To provide insights on how P4P programs are influenced by 5 key elements: whom, what, how, how many targets, and how much to reward. METHODS A qualitative longitudinal analysis of 10 years of P4P reward schemes adopted by the regional administrations of Tuscany and Lombardy (Italy) was conducted. The effects of the P4P features on performance are discussed considering both overall and specific indicators. RESULTS Both regions applied financial reward schemes for General Managers by linking the variable pay to performance. While Tuscany maintained a relatively stable financial incentive design and governance tools, Lombardy changed some elements of the design and introduced, in 2012, a P4P program aimed to reward the providers. The main differences between the 2 cases regard the number of targets (how many), the type (what), and the method applied to set targets (how). CONCLUSION Considering the overall performance obtained by the 2 regions, it seems that whom, how, and how much to reward are not relevant in the success of P4P programs; instead, the number (how many) and the type (what) of targets set may influence the performance improvement processes driven by financial reward schemes.
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Affiliation(s)
- Milena Vainieri
- Laboratorio Management e Sanità―Institute of ManagementScuola Superiore Sant'Anna of PisaPisaItaly
| | - Daniel Adrian Lungu
- Laboratorio Management e Sanità―Institute of ManagementScuola Superiore Sant'Anna of PisaPisaItaly
| | - Sabina Nuti
- Laboratorio Management e Sanità―Institute of ManagementScuola Superiore Sant'Anna of PisaPisaItaly
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175
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Abstract
BACKGROUND Payment models for palliative care vary across nations, with few adopting contemporary payments designs that apply to other parts of the health system. AIM To propose optimal payment arrangements for palliative care. APPROACH Review of relevant literature on funding mechanisms in health care generally and palliative care in particular. RESULTS Payment models for palliative care should move toward activity-based funding using an agreed classification, be uncapped funding with performance monitoring, and make explicit use of performance metrics and reporting. CONCLUSIONS If palliative care is to become a universally accessible service, new approaches to funding, based on the experience of funding reforms in other parts of the health system, need to be adopted.
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Affiliation(s)
- Stephen Duckett
- Health Program, Grattan Institute, 8 Malvina Place, Carlton, VIC, 3053, Australia.
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176
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Fausto MCR, Bousquat A, Lima JG, Giovanella L, de Almeida PF, de Mendonça MHM, Seidl H, da Silva ATC. Evaluation of Brazilian Primary Health Care From the Perspective of the Users: Accessible, Continuous, and Acceptable? J Ambul Care Manage 2018; 40 Suppl 2 Supplement, The Brazilian National Program for Improving Primary Care Access and Quality (PMAQ):S60-S70. [PMID: 28252503 PMCID: PMC5338884 DOI: 10.1097/jac.0000000000000183] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of this study was to examine the experience of primary care center (PCC) users in Brazil, classified according to the quality of its structure, in relation to the aspects of accessibility, continuity, and acceptability. The source of information was the National Program to Improve Access and Quality of Primary Care in 2013-2014. A total of 109 919 interviewees in 24 055 PCCs comprised the sample. Results show that the structure of a PCC was associated with better indicators of accessibility (oral health and medicines) and continuity of care (patient navigation in the health system). No association was found between indicators of accessibility and the PCC structure.
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Affiliation(s)
| | - Aylene Bousquat
- Escola Nacional de Saúde Pública—Fiocruz, Rio de Janeiro, Brazil
| | | | - Ligia Giovanella
- Escola Nacional de Saúde Pública—Fiocruz, Rio de Janeiro, Brazil
| | | | | | - Helena Seidl
- Escola Nacional de Saúde Pública—Fiocruz, Rio de Janeiro, Brazil
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Binyaruka P, Robberstad B, Torsvik G, Borghi J. Who benefits from increased service utilisation? Examining the distributional effects of payment for performance in Tanzania. Int J Equity Health 2018; 17:14. [PMID: 29378658 PMCID: PMC5789643 DOI: 10.1186/s12939-018-0728-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Payment for performance (P4P) strategies, which provide financial incentives to health workers and/or facilities for reaching pre-defined performance targets, can improve healthcare utilisation and quality. P4P may also reduce inequalities in healthcare use and access by enhancing universal access to care, for example, through reducing the financial barriers to accessing care. However, P4P may also enhance inequalities in healthcare if providers cherry-pick the easier-to-reach patients to meet their performance targets. In this study, we examine the heterogeneity of P4P effects on service utilisation across population subgroups and its implications for inequalities in Tanzania. METHODS We used household data from an evaluation of a P4P programme in Tanzania. We surveyed about 3000 households with women who delivered in the last 12 months prior to the interview from seven intervention and four comparison districts in January 2012 and a similar number of households in 13 months later. The household data were used to generate the population subgroups and to measure the incentivised service utilisation outcomes. We focused on two outcomes that improved significantly under the P4P, i.e. institutional delivery rate and the uptake of antimalarials for pregnant women. We used a difference-in-differences linear regression model to estimate the effect of P4P on utilisation outcomes across the different population subgroups. RESULTS P4P led to a significant increase in the rate of institutional deliveries among women in poorest and in middle wealth status households, but not among women in least poor households. However, the differential effect was marginally greater among women in the middle wealth households compared to women in the least poor households (p = 0.094). The effect of P4P on institutional deliveries was also significantly higher among women in rural districts compared to women in urban districts (p = 0.028 for differential effect), and among uninsured women than insured women (p = 0.001 for differential effect). The effect of P4P on the uptake of antimalarials was equally distributed across population subgroups. CONCLUSION P4P can enhance equitable healthcare access and use especially when the demand-side barriers to access care such as user fees associated with drug purchase due to stock-outs have been reduced.
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Affiliation(s)
- Peter Binyaruka
- Centre for International Health, University of Bergen, PO Box 7804, N-5020 Bergen, Norway
- Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania
- Chr. Michelsen Institute, PO Box 6033, Bergen, Norway
| | - Bjarne Robberstad
- Centre for International Health, University of Bergen, PO Box 7804, N-5020 Bergen, Norway
| | - Gaute Torsvik
- Chr. Michelsen Institute, PO Box 6033, Bergen, Norway
- Department of Economics, University of Oslo, PO Box 1095, Oslo, Norway
| | - Josephine Borghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
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Serneels P, Lievens T. Microeconomic institutions and personnel economics for health care delivery: a formal exploration of what matters to health workers in Rwanda. HUMAN RESOURCES FOR HEALTH 2018; 16:7. [PMID: 29373966 PMCID: PMC5787262 DOI: 10.1186/s12960-017-0261-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/04/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Most developing countries face important challenges regarding the quality of health care, and there is a growing consensus that health workers play a key role in this process. Our understanding as to what are the key institutional challenges in human resources, and their underlying driving forces, is more limited. A conceptual framework that structures existing insights and provides concrete directions for policymaking is also missing. METHODS To gain a bottom-up perspective, we gather qualitative data through semi-structured interviews with different levels of health workers and users of health services in rural and urban Rwanda. We conducted discussions with 48 health workers and 25 users of health services in nine different groups in 2005. We maximized within-group heterogeneity by selecting participants using specific criteria that affect health worker performance and career choice. The discussion were analysed electronically, to identify key themes and insights, and are documented with a descriptive quantitative analysis relating to the associations between quotations. The findings from this research are then revisited 10 years later making use of detailed follow-up studies that have been carried out since then. RESULTS The original discussions identified both key challenges in human resources for health and driving forces of these challenges, as well as possible solutions. Two sets of issues were highlighted: those related to the size and distribution of the workforce and those related to health workers' on-the-job performance. Among the latter, four categories were identified: health workers' poor attitudes towards patients, absenteeism, corruption and embezzlement and lack of medical skills among some categories of health workers. The discussion suggest that four components constitute the deeper causal factors, which are, ranked in order of ease of malleability, incentives, monitoring arrangements, professional and workplace norms and intrinsic motivation. Three institutional innovations are identified that aim at improving performance: performance pay, community health workers and increased attention to training of health workers. Revisiting the findings from this primary research making use of later in-depth studies, the analysis demonstrates their continued relevance and usefulness. We discuss how the different factors affect the quality of care by impacting on health worker performance and labour market choices, making use of insights from economics and development studies on the role of institutions. CONCLUSION The study results indicate that health care quality to an important degree depends on four institutional factors at the microlevel that strongly impact on health workers' performance and career choice, and which deserve more attention in applied research and policy reform. The analysis also helps to identify ways forwards, which fit well with the Ministry's most recent strategic plan.
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Expanding the breadth of Medicare: learning from Australia. HEALTH ECONOMICS POLICY AND LAW 2018; 13:344-368. [DOI: 10.1017/s1744133117000421] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThe design of Australia’s Medicare programme was based on the Canadian scheme, adapted somewhat to take account of differences in the constitutional division of powers in the two countries and differences in history. The key elements are very similar: access to hospital services without charge being the core similarity, universal coverage for necessary medical services, albeit with a variable co-payment in Australia, the other. But there are significant differences between the two countries in health programmes – whether or not they are labelled as ‘Medicare’. This paper discusses four areas where Canada could potentially learn from Australia in a positive way. First, Australia has had a national Pharmaceutical Benefits Scheme for almost 70 years. Second, there have been hesitant extensions to Australia’s Medicare to address the increasing prevalence of people with chronic conditions – extensions which include some payments for allied health professionals, ‘care coordination’ payments, and exploration of ‘health care homes’. Third, Australia has a much more extensive system of support for older people to live in their homes or to move into supported residential care. Fourth, Australia has gone further in driving efficiency in the hospital sector than has Canada. Finally, the paper examines aspects of the Australian health care system that Canada should avoid, including the very high level of out-of-pocket costs, and the role of private acute inpatient provision.
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180
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Konetzka RT, Skira MM, Werner RM. Incentive Design and Quality Improvements: Evidence from State Medicaid Nursing Home Pay-for-Performance Programs. AMERICAN JOURNAL OF HEALTH ECONOMICS 2018; 4:105-130. [PMID: 29594189 PMCID: PMC5868417 DOI: 10.1162/ajhe_a_00095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Pay-for-performance (P4P) programs have become a popular policy tool aimed at improving health care quality. We analyze how incentive design affects quality improvements in the nursing home setting, where several state Medicaid agencies have implemented P4P programs that vary in incentive structure. Using the Minimum Data Set and the Online Survey, Certification, and Reporting data from 2001 to 2009, we examine how the weights put on various performance measures that are tied to P4P bonuses, such as clinical outcomes, inspection deficiencies, and staffing levels, affect improvements in those measures. We find larger weights on clinical outcomes often lead to larger improvements, but small weights can lead to no improvement or worsening of some clinical outcomes. We find a qualifier for P4P eligibility based on having few or no severe inspection deficiencies is more effective at decreasing inspection deficiencies than using weights, suggesting simple rules for participation may incent larger improvement.
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Affiliation(s)
| | | | - Rachel M. Werner
- Division of General Internal Medicine, University of Pennsylvania
- Center for Health Equity Research and Promotion, Crescenz VA Medical Center Philadelphia, PA
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181
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Lunney M, Alrukhaimi M, Ashuntantang GE, Bello AK, Bellorin-Font E, Benghanem Gharbi M, Jha V, Johnson DW, Kalantar-Zadeh K, Kazancioglu R, Olah ME, Olanrewaju TO, Osman MA, Parpia Y, Perl J, Rashid HU, Rateb A, Rondeau E, Sola L, Tchokhonelidze I, Tonelli M, Wiebe N, Wirzba I, Yang CW, Ye F, Zemchenkov A, Zhao MH, Levin A. Guidelines, policies, and barriers to kidney care: findings from a global survey. Kidney Int Suppl (2011) 2018; 8:30-40. [PMID: 30675437 DOI: 10.1016/j.kisu.2017.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
An international survey led by the International Society of Nephrology in 2016 assessed the current capacity of kidney care worldwide. To better understand how governance and leadership guide kidney care, items pertinent to government priority, advocacy, and guidelines, among others, were examined. Of the 116 responding countries, 36% (n = 42) reported CKD as a government health care priority, which was associated with having an advocacy group (χ2 = 11.57; P = 0.001). Nearly one-half (42%; 49 of 116) of countries reported an advocacy group for CKD, compared with only 19% (21 of 112) for AKI. Over one-half (59%; 68 of 116) of countries had a noncommunicable disease strategy. Similarly, 44% (48 of 109), 55% (57 of 104), and 47% (47 of 101) of countries had a strategy for nondialysis CKD, chronic dialysis, and kidney transplantation, respectively. Nearly one-half (49%; 57 of 116) reported a strategy for AKI. Most countries (79%; 92 of 116) had access to CKD guidelines and just over one-half (53%; 61 of 116) reported guidelines for AKI. Awareness and adoption of guidelines were low among nonnephrologist physicians. Identified barriers to kidney care were factors related to patients, such as knowledge and attitude (91%; 100 of 110), physicians (84%; 92 of 110), and geography (74%; 81 of 110). Specific to renal replacement therapy, patients and geography were similarly identified as a barrier in 78% (90 of 116) and 71% (82 of 116) of countries, respectively, with the addition of nephrologists (72%; 83 of 116) and the health care system (73%; 85 of 116). These findings inform how kidney care is currently governed globally. Ensuring that guidelines are feasible and distributed appropriately is important to enhancing their adoption, particularly in primary care. Furthermore, increasing advocacy and government priority, especially for AKI, may increase awareness and strategies to better guide kidney care.
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Affiliation(s)
- Meaghan Lunney
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Gloria E Ashuntantang
- Faculty of Medicine and Biomedical Sciences, Yaounde General Hospital, University of Yaounde I, Yaounde, Cameroon
| | - Aminu K Bello
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Ezequiel Bellorin-Font
- Division of Nephrology and Kidney Transplantation, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela
| | - Mohammed Benghanem Gharbi
- Urinary Tract Diseases Department, Faculty of Medicine and Pharmacy of Casablanca, University Hassan II of Casablanca, Casablanca, Morocco
| | - Vivekanand Jha
- George Institute for Global Health India, New Delhi, India.,University of Oxford, Oxford, UK
| | - David W Johnson
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia.,Department of Nephrology, Metro South and Ipswich Nephrology and Transplant Services (MINTS), Princess Alexandra Hospital, Brisbane, Australia
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, California, USA
| | | | - Michelle E Olah
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Mohamed A Osman
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Yasin Parpia
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey Perl
- Division of Nephrology, St. Michael's Hospital and the Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Harun Ur Rashid
- Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Ahmed Rateb
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Eric Rondeau
- Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hopitaux de Paris, Paris, France.,Université Paris VI, Paris, France
| | - Laura Sola
- Division Epidemiologia, Direccion General de Salud-Ministerio Salud Publica, Montevideo, Uruguay
| | - Irma Tchokhonelidze
- Nephrology Development Clinical Center, Tbilisi State Medical University, Tbilisi, Georgia
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Natasha Wiebe
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Isaac Wirzba
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Chih-Wei Yang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Feng Ye
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Alexander Zemchenkov
- Department of Internal Diseases and Nephrology, North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia.,Department of Nephrology and Dialysis, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Key Lab of Renal Disease, Ministry of Health of China, Beijing, China.,Key Lab of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Beijing, China
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
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182
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Paul E, Albert L, Bisala BN, Bodson O, Bonnet E, Bossyns P, Colombo S, De Brouwere V, Dumont A, Eclou DS, Gyselinck K, Hane F, Marchal B, Meloni R, Noirhomme M, Noterman JP, Ooms G, Samb OM, Ssengooba F, Touré L, Turcotte-Tremblay AM, Van Belle S, Vinard P, Ridde V. Performance-based financing in low-income and middle-income countries: isn't it time for a rethink? BMJ Glob Health 2018; 3:e000664. [PMID: 29564163 PMCID: PMC5859812 DOI: 10.1136/bmjgh-2017-000664] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 12/14/2017] [Accepted: 12/15/2017] [Indexed: 01/01/2023] Open
Abstract
This paper questions the view that performance-based financing (PBF) in the health sector is an effective, efficient and equitable approach to improving the performance of health systems in low-income and middle-income countries (LMICs). PBF was conceived as an open approach adapted to specific country needs, having the potential to foster system-wide reforms. However, as with many strategies and tools, there is a gap between what was planned and what is actually implemented. This paper argues that PBF as it is currently implemented in many contexts does not satisfy the promises. First, since the start of PBF implementation in LMICs, concerns have been raised on the basis of empirical evidence from different settings and disciplines that indicated the risks, cost and perverse effects. However, PBF implementation was rushed despite insufficient evidence of its effectiveness. Second, there is a lack of domestic ownership of PBF. Considering the amounts of time and money it now absorbs, and the lack of evidence of effectiveness and efficiency, PBF can be characterised as a donor fad. Third, by presenting itself as a comprehensive approach that makes it possible to address all aspects of the health system in any context, PBF monopolises attention and focuses policy dialogue on the short-term results of PBF programmes while diverting attention and resources from broader processes of change and necessary reforms. Too little care is given to system-wide and long-term effects, so that PBF can actually damage health services and systems. This paper ends by proposing entry points for alternative approaches.
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Affiliation(s)
- Elisabeth Paul
- Tax Institute, Université de Liège, Liège, Belgium
- Faculty of Social Sciences, Université de Liège, Liège, Belgium
| | - Lucien Albert
- International Health Unit, University of Montreal, Montreal, Quebec, Canada
| | - Badibanga N'Sambuka Bisala
- Expert in district health systems based on primary healthcare, Groupe d'Appui à la Recherche et Enseignement en Santé Publique, Mbuji-Mayi, Democratic Republic of the Congo
| | - Oriane Bodson
- Faculty of Social Sciences, Université de Liège, Liège, Belgium
| | - Emmanuel Bonnet
- Résiliences, Research Institute for Development (IRD), Bondy, France
| | - Paul Bossyns
- Health Sector Thematic Unit, Belgian Development Agency (ENABEL), Brussels, Belgium
| | | | - Vincent De Brouwere
- Department of Public Health, Institute of Tropical Medicine Antwerp, Antwerpen, Belgium
| | - Alexandre Dumont
- CEPED, Research Institute for Development (IRD), Paris Descartes University, INSERM, Paris, France
| | | | - Karel Gyselinck
- Health Sector Thematic Unit, Belgian Development Agency (ENABEL), Brussels, Belgium
| | - Fatoumata Hane
- Department of Sociology, Université Assane Seck, Ziguinchor, Senegal
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine Antwerp, Antwerpen, Belgium
| | | | | | | | - Gorik Ooms
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Oumar Mallé Samb
- Global Health, Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Quebec City, Quebec, Canada
| | - Freddie Ssengooba
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Laurence Touré
- Anthropologist, Research Association Miseli, Bamako, Mali
| | | | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine Antwerp, Antwerpen, Belgium
| | | | - Valéry Ridde
- CEPED, Research Institute for Development (IRD), Paris Descartes University, INSERM, Paris, France
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183
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Lamster IB. Geriatric periodontology: how the need to care for the aging population can influence the future of the dental profession. Periodontol 2000 2018; 72:7-12. [PMID: 27501487 DOI: 10.1111/prd.12157] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2016] [Indexed: 12/31/2022]
Abstract
The world's population is aging, and it has been estimated that by 2050, the number of people 65 years of age and older will reach 1.5 billion. The aging population will be affected by noncommunicable chronic diseases, including diabetes mellitus, cardiovascular disease and cognitive impairment. This important demographic shift includes a reduction in tooth loss/edentulism, particularly in older adults of the developed countries in North America, western Europe and north-east Asia. Therefore, in the future, dental providers will be required to care for an expanded number of older adults who have retained teeth and are medically complex. As the linkage of oral disease and systemic disease has focused on the relationship of periodontitis and noncommunicable chronic diseases, a broad review of 'geriatric periodontology' is both timely and important. This volume of Periodontology 2000 covers a range of subjects under this heading. Included are the demographics of an aging world; the effect of aging on stem cell function in the periodontium; the periodontal microbiota associated with aging; the host response in the periodontium of aging individuals; an analysis of the prevalence of periodontitis in the USA on a national, state-wide and community basis; differentiation of physiologic oral aging from disease; treatment of periodontal disease in older adults; implant therapy for older patients; oral disease and the frailty syndrome; the relationship of tooth loss to longevity and life expectancy; and the relationship of periodontal disease to noncommunicable chronic diseases. Although 'geriatric dentistry' is not a recognized specialty in dentistry, and 'geriatric periodontology' is a descriptive title, the subject of this volume of Periodontology 2000 is critical to the future of clinical dentistry, dental public health and dental research. Any comprehensive focus on older patients can only be accomplished with an emphasis on interprofessional education and practice. If embraced, this shift will allow the dental profession to be more closely aligned with the larger health-care environment, and can improve both oral health and health outcomes for patients seen in the dental office.
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184
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Bonfrer I, Figueroa JF, Zheng J, Orav EJ, Jha AK. Impact of Financial Incentives on Early and Late Adopters among US Hospitals: observational study. BMJ 2018; 360:j5622. [PMID: 29298765 PMCID: PMC5749590 DOI: 10.1136/bmj.j5622] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To examine how hospitals that volunteered to be under financial incentives for more than a decade as part of the Premier Hospital Quality Incentive Demonstration (early adopters) compared with similar hospitals where these incentives were implemented later under the Hospital Value-Based Purchasing program (late adopters). DESIGN Observational study. SETTING 1189 hospitals in the USA (214 early adopters and 975 matched late adopters), using Hospital Compare data from 2003 through 2013. PARTICIPANTS 1 371 364 patients aged 65 years and older, using 100% Medicare claims. MAIN OUTCOME MEASURES Clinical process scores and 30 day mortality. RESULTS Early adopters started from a slightly higher baseline of clinical process scores (92) than late adopters (90). Both groups reached a ceiling (98) a decade later. Starting from a similar baseline, just below 13%, early and late adopters did not have significantly (P=0.25) different mortality trends for conditions targeted by the program (0.05% point difference quarterly) or for conditions not targeted by the program (-0.02% point difference quarterly). CONCLUSIONS No evidence that hospitals that have been operating under pay for performance programs for more than a decade had better process scores or lower mortality than other hospitals was found. These findings suggest that even among hospitals that volunteered to participate in pay for performance programs, having additional time is not likely to turn pay for performance programs into a success in the future.
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Affiliation(s)
- Igna Bonfrer
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, 42 Church St, Cambridge, MA 02138, USA
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Jose F Figueroa
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, 42 Church St, Cambridge, MA 02138, USA
- Department of Medicine, Harvard Medical School, Cambridge, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jie Zheng
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, 42 Church St, Cambridge, MA 02138, USA
| | - E John Orav
- Department of Medicine, Harvard Medical School, Cambridge, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Biostatistics, Harvard T H Chan School of Public Health, Cambridge, MA, USA
| | - Ashish K Jha
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, 42 Church St, Cambridge, MA 02138, USA
- Department of Medicine, Harvard Medical School, Cambridge, MA, USA
- Department of General Internal Medicine, VA Boston Healthcare System, Boston, MA, USA
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185
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Maas MJ, Driehuis F, Meerhoff GA, Heerkens YF, van der Vleuten CP, Nijhuis-van der Sanden MW, van der Wees PJ. Impact of Self- and Peer Assessment on the Clinical Performance of Physiotherapists in Primary Care: A Cohort Study. Physiother Can 2018; 70:393-401. [PMID: 30745725 PMCID: PMC6361404 DOI: 10.3138/ptc.2017-40.pc] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: This study evaluated the impact of a quality improvement programme based on self- and peer assessment to justify nationwide implementation. Method: Four professional networks of physiotherapists in The Netherlands (n = 379) participated in the programme, which consisted of two cycles of online self-assessment and peer assessment using video recordings of client communication and clinical records. Assessment was based on performance indicators that could be scored on a 5-point Likert scale, and online assessment was followed by face-to-face feedback discussions. After cycle 1, participants developed personal learning goals. These goals were analyzed thematically, and goal attainment was measured using a questionnaire. Improvement in performance was tested with multilevel regression analyses, comparing the self-assessment and peer-assessment scores in cycles 1 and 2. Results: In total, 364 (96%) of the participants were active in online self-assessment and peer assessment. However, online activities varied between cycle 1 and cycle 2 and between client communication and recordkeeping. Personal goals addressed client-centred communication (54%), recordkeeping (24%), performance and outcome measurement (15%), and other (7%). Goals were completely attained (29%), partly attained (64%), or not attained at all (7%). Self-assessment and peer-assessment scores improved significantly for both client communication (self-assessment = 11%; peer assessment = 8%) and recordkeeping (self-assessment = 7%; peer assessment = 4%). Conclusions: Self-assessment and peer assessment are effective in enhancing commitment to change and improving clinical performance. Nationwide implementation of the programme is justified. Future studies should address the impact on client outcomes.
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Affiliation(s)
- Marjo J.M. Maas
- Institute of Health Studies, HAN University of Applied Sciences
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen
| | - Femke Driehuis
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen
| | - Guus A. Meerhoff
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen
| | - Yvonne F. Heerkens
- Institute of Health Studies, HAN University of Applied Sciences
- Dutch Institute of Allied Healthcare, Amersfoort
| | - Cees P.M. van der Vleuten
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | - Philip J. van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen
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186
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Ellegård LM, Dietrichson J, Anell A. Can pay-for-performance to primary care providers stimulate appropriate use of antibiotics? HEALTH ECONOMICS 2018; 27:e39-e54. [PMID: 28685902 PMCID: PMC5836891 DOI: 10.1002/hec.3535] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 03/27/2017] [Accepted: 05/15/2017] [Indexed: 05/05/2023]
Abstract
Antibiotic resistance is a major threat to public health worldwide. As the healthcare sector's use of antibiotics is an important contributor to the development of resistance, it is crucial that physicians only prescribe antibiotics when needed and that they choose narrow-spectrum antibiotics, which act on fewer bacteria types, when possible. Inappropriate use of antibiotics is nonetheless widespread, not least for respiratory tract infections (RTI), a common reason for antibiotics prescriptions. We examine if pay-for-performance (P4P) presents a way to influence primary care physicians' choice of antibiotics. During 2006-2013, 8 Swedish healthcare authorities adopted P4P to make physicians select narrow-spectrum antibiotics more often in the treatment of children with RTI. Exploiting register data on all purchases of RTI antibiotics in a difference-in-differences analysis, we find that P4P significantly increased the share of narrow-spectrum antibiotics. There are no signs that physicians gamed the system by issuing more prescriptions overall.
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Affiliation(s)
| | - Jens Dietrichson
- SFIThe Danish National Centre for Social ResearchCopenhagenDenmark
| | - Anders Anell
- Department of Business AdministrationLund UniversityLundSweden
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187
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Leijten FR, Struckmann V, van Ginneken E, Czypionka T, Kraus M, Reiss M, Tsiachristas A, Boland M, de Bont A, Bal R, Busse R, Rutten-van Mölken M. The SELFIE framework for integrated care for multi-morbidity: Development and description. Health Policy 2018; 122:12-22. [DOI: 10.1016/j.healthpol.2017.06.002] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 05/31/2017] [Accepted: 06/12/2017] [Indexed: 12/17/2022]
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188
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Lavergne MR, Law MR, Peterson S, Garrison S, Hurley J, Cheng L, McGrail K. Effect of incentive payments on chronic disease management and health services use in British Columbia, Canada: Interrupted time series analysis. Health Policy 2017; 122:157-164. [PMID: 29153847 DOI: 10.1016/j.healthpol.2017.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 10/11/2017] [Accepted: 11/02/2017] [Indexed: 11/29/2022]
Abstract
We studied the effects of incentive payments to primary care physicians for the care of patients with diabetes, hypertension, and Chronic Obstructive Pulmonary Disease (COPD) in British Columbia, Canada. We used linked administrative health data to examine monthly primary care visits, continuity of care, laboratory testing, pharmaceutical dispensing, hospitalizations, and total h ealth care spending. We examined periods two years before and two years after each incentive was introduced, and used segmented regression to assess whether there were changes in level or trend of outcome measures across all eligible patients following incentive introduction, relative to pre-intervention periods. We observed no increases in primary care visits or continuity of care after incentives were introduced. Rates of ACR testing and antihypertensive dispensing increased among patients with hypertension, but none of the other modest increases in laboratory testing or prescriptions dispensed reached statistical significance. Rates of hospitalizations for stroke and heart failure among patients with hypertension fell relative to pre-intervention patterns, while hospitalizations for COPD increased. Total hospitalizations and hospitalizations via the emergency department did not change. Health care spending increased for patients with hypertension. This large-scale incentive scheme for primary care physicians showed some positive effects for patients with hypertension, but we observe no similar changes in patient management, reductions in hospitalizations, or changes in spending for patients with diabetes and COPD.
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Affiliation(s)
- M Ruth Lavergne
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 10502, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| | - Michael R Law
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada
| | - Sandra Peterson
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada
| | - Scott Garrison
- Department of Family Medicine, University of Alberta, 6-60 University Terrace, Edmonton, AB T6G 2T4, Canada
| | - Jeremiah Hurley
- Department of Economics, and Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Lucy Cheng
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada
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189
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Affiliation(s)
- Kathleen M Stacy
- Kathleen M. Stacy is Critical Care Clinical Nurse Specialist and Clinical Associate Professor, Hahn School of Nursing and Health Science, University of San Diego, 5998 Alcala Park, San Diego, CA 92110-2492
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190
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Calcaterra SL, Drabkin AD, Doyle R, Leslie SE, Binswanger IA, Frank JW, Reich JA, Koester S. A Qualitative Study of Hospitalists' Perceptions of Patient Satisfaction Metrics on Pain Management. Hosp Top 2017; 95:18-26. [PMID: 28362247 DOI: 10.1080/00185868.2017.1300479] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Hospital initiatives to promote pain management may unintentionally contribute to excessive opioid prescribing. To better understand hospitalists' perceptions of satisfaction metrics on pain management, the authors conducted 25 interviews with hospitalists. Transcribed interviews were systematically analyzed to identify emergent themes. Hospitalists felt institutional pressure to earn high satisfaction scores for pain, which they perceived influenced practices toward opioid prescribing. They felt tying compensation to satisfaction scores commoditized pain. Hospitalists believed satisfaction would improve with increased time spent at the bedside. Focusing on methods to improve patient-physician communication, while maintaining efficiency in clinical practice, may promote both patient-centered pain management and satisfaction.
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Affiliation(s)
- Susan L Calcaterra
- a Department of Hospital Medicine , Denver Health Medical Center , Denver , Colorado , USA.,b Division of General Internal Medicine, Department of Medicine , University of Colorado School of Medicine , Aurora , Colorado , USA
| | - Anne D Drabkin
- a Department of Hospital Medicine , Denver Health Medical Center , Denver , Colorado , USA.,b Division of General Internal Medicine, Department of Medicine , University of Colorado School of Medicine , Aurora , Colorado , USA
| | - Reina Doyle
- c Center for Health Systems Research, Denver Health Medical Center , Denver , Colorado , USA
| | - Sarah E Leslie
- c Center for Health Systems Research, Denver Health Medical Center , Denver , Colorado , USA
| | - Ingrid A Binswanger
- b Division of General Internal Medicine, Department of Medicine , University of Colorado School of Medicine , Aurora , Colorado , USA.,h Kaiser Permanente Colorado Institute for Health Research , Denver , Colorado , USA
| | - Joseph W Frank
- b Division of General Internal Medicine, Department of Medicine , University of Colorado School of Medicine , Aurora , Colorado , USA.,d VA Eastern Colorado Health Care System , Denver , Colorado , USA
| | - Jennifer A Reich
- e Department of Sociology , University of Colorado , Denver , Colorado , USA
| | - Stephen Koester
- f Department of Anthropology , University of Colorado , Denver , Colorado , USA.,g Department of Health and Behavioral Sciences , University of Colorado Denver , Denver , Colorado , USA
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Lalloué B, Jiang S, Girault A, Ferrua M, Loirat P, Minvielle E. Evaluation of the effects of the French pay-for-performance program-IFAQ pilot study. Int J Qual Health Care 2017; 29:833-837. [PMID: 29024997 DOI: 10.1093/intqhc/mzx111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 08/09/2017] [Indexed: 12/17/2022] Open
Abstract
Objective Most studies showed no or little effect of pay-for-performance (P4P) programs on different outcomes. In France, the P4P program IFAQ was generalized to all acute care hospitals in 2016. A pilot study was launched in 2012 to design, implement and assess this program. This article aims to assess the immediate impact of the 2012-14 pilot study. Design and setting From nine process quality indicators (QIs), an aggregated score was constructed as the weighted average, taking into account both achievement and improvement. Among 426 eligible volunteer hospitals, 222 were selected to participate. Eligibility depended on documentation of QIs and results of hospital accreditation. Hospitals with scores above the median received a financial reward based on their ranking and budget. Several characteristics known to have an influence on P4P results (patient age, socioeconomic status, hospital activity, casemix and location) were used to adjust the models. Intervention To assess the effect of the program, comparison between the 185 eligible selected hospitals and the 192 eligible not selected volunteers were done using the difference-in-differences method. Results Whereas all hospitals improved from 2012 to 2014, the difference-in-differences effect was positive but not significant both in the crude (2.89, P = 0.29) and adjusted models (4.07, P = 0.12). Conclusion These results could be explained by several reasons: low level of financial incentives, unattainable goals, too short study period. However, the lack of impact for the first year should not undermine the implementation of other P4P programs. Indeed, the pilot study helped to improve the final model used for generalization.
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Affiliation(s)
- Benoît Lalloué
- EA 7348 MOS-EHESP.,Gustave Roussy 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - Shu Jiang
- EA 7348 MOS-EHESP.,Gustave Roussy 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | | | - Marie Ferrua
- Gustave Roussy 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - Philippe Loirat
- EA 7348 MOS-EHESP.,Gustave Roussy 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - Etienne Minvielle
- EA 7348 MOS-EHESP.,Gustave Roussy 114, rue Édouard-Vaillant, 94805 Villejuif, France
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192
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Anell A, Hagberg O, Liedberg F, Ryden S. A randomized comparison between league tables and funnel plots to inform health care decision-making. Int J Qual Health Care 2017; 28:816-823. [PMID: 28423165 DOI: 10.1093/intqhc/mzw125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 09/06/2016] [Indexed: 11/13/2022] Open
Abstract
Objective Comparison of provider performance is commonly used to inform health care decision-making. Little attention has been paid to how data presentations influence decisions. This study analyzes differences in suggested actions by decision-makers informed by league tables or funnel plots. Design Decision-makers were invited to a survey and randomized to compare hospital performance using either league tables or funnel plots for four different measures within the area of cancer care. For each measure, decision-makers were asked to suggest actions towards 12-16 hospitals (no action, ask for more information, intervene) and provide feedback related to whether the information provided had been useful. Setting Swedish health care. Participants Two hundred and twenty-one decision-makers at administrative and clinical levels. Intervention Data presentations in the form of league tables or funnel plots. Main outcome measures Number of actions suggested by participants. Proportion of appropriate actions. Results For all four measures, decision-makers tended to suggest more actions based on the information provided in league tables compared to funnel plots (44% vs. 21%, P < 0.001). Actions were on average more appropriate for funnel plots. However, when using funnel plots, decision-makers more often missed to react even when appropriate. Conclusions The form of data presentation had an influence on decision-making. With league tables, decision-makers tended to suggest more actions compared to funnel plots. A difference in sensitivity and specificity conditioned by the form of presentation could also be identified, with different implications depending on the purpose of comparisons. Explanations and visualization aids are needed to support appropriate actions.
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Affiliation(s)
- Anders Anell
- Department of Business Administration, Lund University School of Economics and Management, P.O. Box 7080, SE-220 07 Lund, Sweden
| | - Oskar Hagberg
- Regional Cancer Centre South, Scheelev. 2, SE-223 81 Lund, Sweden
| | - Fredrik Liedberg
- Section of Urology, Skåne University Hospital, Malmö, Sweden.,Department of Translational Medicine, Faculty of Medicine, Lund University, J. Waldenströmsg. 35, SE-205 02 Lund, Sweden
| | - Stefan Ryden
- Regional Cancer Centre South, Scheelev. 2, SE-223 81 Lund, Sweden
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193
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A Policy Guide on Integrated Care (PGIC): Lessons Learned from EU Project INTEGRATE and Beyond. Int J Integr Care 2017; 17:8. [PMID: 29588631 PMCID: PMC5854173 DOI: 10.5334/ijic.3295] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Efforts are underway in many European countries to channel efforts into creating improved integrated health and social care services. But most countries lack a strategic plan that is sustainable over time, and that reflects a comprehensive systems perspective. The Policy Guide on Integrated Care (PGIC) as presented in this paper resulted from experiences with the EU Project INTEGRATE and our own work with healthcare reform for patients with chronic conditions at the national and international level. This project is one of the largest EU funded projects on Integrated Care, conducted over a four-year period (2012–2016) and included partners from nine European countries. Project Integrate aimed to gain insights into the leadership, management and delivery of integrated care to support European care systems to respond to the challenges of ageing populations and the rise of people living with long-term conditions. The objective of this paper is to describe the PGIC as both a tool and a reasoning flow that aims at supporting policy makers at the national and international level with the development and implementation of integrated care. Any Policy Guide on Integrated should build upon three building blocks, being a mission, vision and a strategy that aim at capturing the large amount of factors that directly or indirectly influence the successful development of integrated care.
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194
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Ödesjö H, Anell A, Boman A, Fastbom J, Franzén S, Thorn J, Björck S. Pay for performance associated with increased volume of medication reviews but not with less inappropriate use of medications among the elderly - an observational study. Scand J Prim Health Care 2017; 35:271-278. [PMID: 28830291 PMCID: PMC5592354 DOI: 10.1080/02813432.2017.1358434] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE A pay for performance programme was introduced in 2009 by a Swedish county with 1.6 million inhabitants. A process measure with payment linked to coding for medication reviews among the elderly was adopted. We assessed the association with inappropriate medication for five years after baseline. DESIGN AND SETTING Observational study that compared medication for elderly patients enrolled at primary care units that coded for a high or low volume of medication reviews. PATIENTS 144,222 individuals at 196 primary care centres, age 75 or older. MAIN OUTCOME MEASURES Percentage of patients receiving inappropriate drugs or polypharmacy during five years at primary care units with various levels of reported medication reviews. RESULTS The proportion of patients with a registered medication review had increased from 3.2% to 44.1% after five years. The high-coding units performed better for most indicators but had already done so at baseline. Primary care units with the lowest payment for coding for medication reviews improved just as well in terms of inappropriate drugs as units with the highest payment - from 13.0 to 8.5%, compared to 11.6 to 7.4% and from 13.6 to 7.2% vs 11.8 to 6.5% for polypharmacy. CONCLUSIONS Payment linked to coding for medication reviews was associated with an increase in the percentage of patients for whom a medication review had been registered. However, the impact of payment on quality improvement is uncertain, given that units with the lowest payment for medication reviews improved equally well as units with the highest payment.
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Affiliation(s)
- H. Ödesjö
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
- CONTACT Helena Ödesjö Primary Health Care, Region Västra Götaland, Närhälsan Torslanda Vårdcentral, Nordhagsvägen 2A, SE-423 34 Torslanda, Sweden
| | - A. Anell
- Lund University School of Economics and Management, Lund, Sweden
| | - A. Boman
- Department of Economics, School of Business, Economics and Law, University of Gothenburg, Gothenburg, Sweden
| | - J. Fastbom
- Aging Research Centre, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - S. Franzén
- Centre of Registers, Region Västra Götaland, Gothenburg, Sweden
| | - J. Thorn
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
| | - S. Björck
- Centre of Registers, Region Västra Götaland, Gothenburg, Sweden
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195
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Gebauer SL, Weiskopf NG. Feasibility and Limitations of Quality Measurement of Hospital-Based Palliative Care. J Palliat Med 2017; 20:1307-1308. [PMID: 28829228 DOI: 10.1089/jpm.2017.0131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sarah L Gebauer
- 1 Department of Anesthesiology and Critical Care Medicine, University of New Mexico , Albuquerque, New Mexico
| | - Nicole G Weiskopf
- 2 Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University , Portland, Oregon
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196
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Otts JAA, Pearce PF, Langford CA. Effectiveness of pay-for-performance for chronic kidney disease patients on hemodialysis: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:1850-1855. [PMID: 28708749 DOI: 10.11124/jbisrir-2016-003144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of this review is to assess the evidence on the effectiveness of implementation of a pay-for-performance program on clinical outcomes in the adult chronic kidney disease (CKD) patient receiving hemodialysis.The review question is: What is the effectiveness of implementation of a pay-for-performance program on clinical outcomes in the adult CKD patient receiving hemodialysis, as compared to the period immediately before implementation of the program?More specifically, the objectives are to identify.
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Affiliation(s)
- Jo Ann A Otts
- 1School of Nursing, Loyola University New Orleans, New Orleans, USA 2Texas Christian University Center for Translational Research: a Joanna Briggs Institute Center of Excellence, Fort Worth, USA
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Sood A, Meyer CP, Abdollah F, Sammon JD, Sun M, Lipsitz SR, Hollis M, Weissman JS, Menon M, Trinh QD. Minimally invasive surgery and its impact on 30-day postoperative complications, unplanned readmissions and mortality. Br J Surg 2017. [PMID: 28632890 DOI: 10.1002/bjs.10561] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND A critical appraisal of the benefits of minimally invasive surgery (MIS) is needed, but is lacking. This study examined the associations between MIS and 30-day postoperative outcomes including complications graded according to the Clavien-Dindo classification, unplanned readmissions, hospital stay and mortality for five common surgical procedures. METHODS Patients undergoing appendicectomy, colectomy, inguinal hernia repair, hysterectomy and prostatectomy were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Non-parsimonious propensity score methods were used to construct procedure-specific matched-pair cohorts that reduced baseline differences between patients who underwent MIS and those who did not. Bonferroni correction for multiple comparisons was applied and P < 0·006 was considered significant. RESULTS Of the 532 287 patients identified, 53·8 per cent underwent MIS. Propensity score matching yielded an overall sample of 327 736 patients (appendicectomy 46 688, colectomy 152 114, inguinal hernia repair 59 066, hysterectomy 59 066, prostatectomy 10 802). Within the procedure-specific matched pairs, MIS was associated with significantly lower odds of Clavien-Dindo grade I-II, III and IV complications (P ≤ 0·004), unplanned readmissions (P < 0·001) and reduced hospital stay (P < 0·001) in four of the five procedures studied, with the exception of inguinal hernia repair. The odds of death were lower in patients undergoing MIS colectomy (P < 0·001), hysterectomy (P = 0·002) and appendicectomy (P = 0·002). CONCLUSION MIS was associated with significantly fewer 30-day postoperative complications, unplanned readmissions and deaths, as well as shorter hospital stay, in patients undergoing colectomy, prostatectomy, hysterectomy or appendicectomy. No benefits were noted for inguinal hernia repair.
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Affiliation(s)
- A Sood
- Center for Outcomes Research, Analytics and Evaluation (VCORE), Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA.,Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - C P Meyer
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - F Abdollah
- Center for Outcomes Research, Analytics and Evaluation (VCORE), Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - J D Sammon
- Center for Outcomes Research, Analytics and Evaluation (VCORE), Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA.,Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - M Sun
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - S R Lipsitz
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - M Hollis
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - J S Weissman
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - M Menon
- Center for Outcomes Research, Analytics and Evaluation (VCORE), Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Q-D Trinh
- Center for Outcomes Research, Analytics and Evaluation (VCORE), Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA.,Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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198
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Kambala C, Lohmann J, Mazalale J, Brenner S, Sarker M, Muula AS, De Allegri M. Perceptions of quality across the maternal care continuum in the context of a health financing intervention: Evidence from a mixed methods study in rural Malawi. BMC Health Serv Res 2017; 17:392. [PMID: 28595576 PMCID: PMC5465597 DOI: 10.1186/s12913-017-2329-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 05/22/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In 2013, Malawi with its development partners introduced a Results-Based Financing for Maternal and Newborn Health (RBF4MNH) intervention to improve the quality of maternal and newborn health-care services. Financial incentives are awarded to health facilities conditional on their performance and to women for delivering in the health facility. We assessed the effect of the RBF4MNH on quality of care from women's perspectives. METHODS We used a mixed-method prospective sequential controlled pre- and post-test design. We conducted 3060 structured client exit interviews, 36 in-depth interviews and 29 focus group discussions (FGDs) with women and 24 in-depth interviews with health service providers between 2013 and 2015. We used difference-in-differences regression models to measure the effect of the RBF4MNH on experiences and perceived quality of care. We used qualitative data to explore the matter more in depth. RESULTS We did not observe a statistically significant effect of the intervention on women's perceptions of technical care, quality of amenities and interpersonal relations. However, in the qualitative interviews, most women reported improved health service provision as a result of the intervention. RBF4MNH increased the proportion of women reporting to have received medications/treatment during childbirth. Participants in interviews expressed that drugs, equipment and supplies were readily available due to the RBF4MNH. However, women also reported instances of neglect, disrespect and verbal abuse during the process of care. Providers attributed these negative instances to an increased workload resulting from an increased number of women seeking services at RBF4MNH facilities. CONCLUSION Our qualitative findings suggest improvements in the availability of drugs and supplies due to RBF4MNH. Despite the intervention, challenges in the provision of quality care persisted, especially with regard to interpersonal relations. RBF interventions may need to consider including indicators that specifically target the provision of respectful maternity care as a means to foster providers' positive attitudes towards women in labour. In parallel, governments should consider enhancing staff and infrastructural capacity before implementing RBF.
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Affiliation(s)
- Christabel Kambala
- Institute of Public Health, Faculty of Medicine, Heidelberg University, Im Neuenheimer Feld 324, D-69120 Heidelberg, Germany
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
- Environmental Health Department, The Malawi Polytechnic, University of Malawi, Private Bag 303, Chichiri, Blantyre 3, Malawi
| | - Julia Lohmann
- Institute of Public Health, Faculty of Medicine, Heidelberg University, Im Neuenheimer Feld 324, D-69120 Heidelberg, Germany
| | - Jacob Mazalale
- Institute of Public Health, Faculty of Medicine, Heidelberg University, Im Neuenheimer Feld 324, D-69120 Heidelberg, Germany
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Stephan Brenner
- Institute of Public Health, Faculty of Medicine, Heidelberg University, Im Neuenheimer Feld 324, D-69120 Heidelberg, Germany
| | - Malabika Sarker
- Institute of Public Health, Faculty of Medicine, Heidelberg University, Im Neuenheimer Feld 324, D-69120 Heidelberg, Germany
- James P. Grant School of Public Health, BRAC University, 66 Mohakhali, Dhaka, 1212 Bangladesh
| | - Adamson S. Muula
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Manuela De Allegri
- Institute of Public Health, Faculty of Medicine, Heidelberg University, Im Neuenheimer Feld 324, D-69120 Heidelberg, Germany
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199
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Herbst T, Emmert M. Characterization and effectiveness of pay-for-performance in ophthalmology: a systematic review. BMC Health Serv Res 2017; 17:385. [PMID: 28583141 PMCID: PMC5460462 DOI: 10.1186/s12913-017-2333-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 05/25/2017] [Indexed: 11/11/2022] Open
Abstract
Background To identify, characterize and compare existing pay-for-performance approaches and their impact on the quality of care and efficiency in ophthalmology. Methods A systematic evidence-based review was conducted. English, French and German written literature published between 2000 and 2015 were searched in the following databases: Medline (via PubMed), NCBI web site, Scopus, Web of Knowledge, Econlit and the Cochrane Library. Empirical as well as descriptive articles were included. Controlled clinical trials, meta-analyses, randomized controlled studies as well as observational studies were included as empirical articles. Systematic characterization of identified pay-for-performance approaches (P4P approaches) was conducted according to the “Model for Implementing and Monitoring Incentives for Quality” (MIMIQ). Methodological quality of empirical articles was assessed according to the Critical Appraisal Skills Programme (CASP) checklists. Results Overall, 13 relevant articles were included. Eleven articles were descriptive and two articles included empirical analyses. Based on these articles, four different pay-for-performance approaches implemented in the United States were identified. With regard to quality and incentive elements, systematic comparison showed numerous differences between P4P approaches. Empirical studies showed isolated cost or quality effects, while a simultaneous examination of these effects was missing. Conclusion Research results show that experiences with pay-for-performance approaches in ophthalmology are limited. Identified approaches differ with regard to quality and incentive elements restricting comparability. Two empirical studies are insufficient to draw strong conclusions about the effectiveness and efficiency of these approaches. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2333-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tim Herbst
- nordBLICK Augenklinik Bellevue, Lindenallee 21-23, 24105, Kiel, Germany.
| | - Martin Emmert
- Friedrich-Alexander-University Erlangen-Nuremberg, School of Business and Economics, Institute of Management (IFM), Lange Gasse 20, 90403, Nuremberg, Germany.
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200
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Sicsic J, Franc C. Impact assessment of a pay-for-performance program on breast cancer screening in France using micro data. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:609-621. [PMID: 27329654 DOI: 10.1007/s10198-016-0813-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/14/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND A voluntary-based pay-for-performance (P4P) program (the CAPI) aimed at general practitioners (GPs) was implemented in France in 2009. The program targeted prevention practices, including breast cancer screening, by offering a maximal amount of €245 for achieving a target screening rate among eligible women enrolled with the GP. OBJECTIVE Our objective was to evaluate the impact of the French P4P program (CAPI) on the early detection of breast cancer among women between 50 and 74 years old. METHODS Based on an administrative database of 50,752 women aged 50-74 years followed between 2007 and 2011, we estimated a difference-in-difference model of breast cancer screening uptake as a function of visit to a CAPI signatory referral GP, while controlling for both supply-side and demand-side determinants (e.g., sociodemographics, health and healthcare use). RESULTS Breast cancer screening rates have not changed significantly since the P4P program implementation. Overall, visiting a CAPI signatory referral GP at least once in the pre-CAPI period increased the probability of undergoing breast cancer screening by 1.38 % [95 % CI (0.41-2.35 %)], but the effect was not significantly different following the implementation of the contract. CONCLUSION The French P4P program had a nonsignificant impact on breast cancer screening uptake. This result may reflect the fact that the low-powered incentives implemented in France through the CAPI might not provide sufficient leverage to generate better practices, thus inviting regulators to seek additional tools beyond P4P in the field of prevention and screening.
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Affiliation(s)
- Jonathan Sicsic
- CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Hôpital Paul Brousse, 16 avenue Paul Vaillant-Couturier, 94807, Villejuif Cedex, France.
| | - Carine Franc
- CESP, Univ. Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Hôpital Paul Brousse, 16 avenue Paul Vaillant-Couturier, 94807, Villejuif Cedex, France
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