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Wagenschieber E, Blunck D. Impact of reimbursement systems on patient care - a systematic review of systematic reviews. HEALTH ECONOMICS REVIEW 2024; 14:22. [PMID: 38492098 PMCID: PMC10944612 DOI: 10.1186/s13561-024-00487-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 02/07/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND There is not yet sufficient scientific evidence to answer the question of the extent to which different reimbursement systems influence patient care and treatment quality. Due to the asymmetry of information between physicians, health insurers and patients, market-based mechanisms are necessary to ensure the best possible patient care. The aim of this study is to investigate how reimbursement systems influence multiple areas of patient care in form of structure, process and outcome indicators. METHODS For this purpose, a systematic literature review of systematic reviews is conducted in the databases PubMed, Web of Science and the Cochrane Library. The reimbursement systems of salary, bundled payment, fee-for-service and value-based reimbursement are examined. Patient care is divided according to the three dimensions of structure, process, and outcome and evaluated in eight subcategories. RESULTS A total of 34 reviews of 971 underlying primary studies are included in this article. International studies identified the greatest effects in categories resource utilization and quality/health outcomes. Pay-for-performance and bundled payments were the most commonly studied models. Among the systems examined, fee-for-service and value-based reimbursement systems have the most positive impact on patient care. CONCLUSION Patient care can be influenced by the choice of reimbursement system. The factors for successful implementation need to be further explored in future research.
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Affiliation(s)
- Eva Wagenschieber
- Department of Healthcare Management, Institute of Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Lange Gasse 20, 90403, Nuremberg, Germany
| | - Dominik Blunck
- Department of Healthcare Management, Institute of Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Lange Gasse 20, 90403, Nuremberg, Germany.
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Value-based surgery physician compensation model: Review of the literature. J Pediatr Surg 2022; 57:118-123. [PMID: 35093253 DOI: 10.1016/j.jpedsurg.2022.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/15/2021] [Accepted: 01/08/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND In recent history, healthcare payment reform and legislative initiatives have drastically altered the practice environment for many physicians. Individual providers have migrated from self-managed smaller practices toward employed positions with larger entities, in which provider productivity is tracked. In academic institutions, surgical departments are tasked with meeting clinical productivity metrics while maintaining research and education missions. The objective was to review the current literature regarding the status of physician compensation. METHODS A narrative review of the literature with a defined search strategy using Pubmed and MEDLINE was performed. Using keywords of physician reimbursement, physician compensation, performance-based incentives, relative value unit, RVU, searches were completed and subsequently reviewed by the authors for inclusion. Subsequently, all review articles had their included studies hand searched by the research team and any relevant articles were included in our review. RESULTS In total, fifteen papers were deemed to meet inclusion criteria. Articles were then divided into 7 domains (Origins of the Work Relative Value Unit, Adjusting for Clinical Complexity, Alternative Compensation Strategies, Aligning Compensation with Department Goals, Individual versus Group Incentives, Minimizing Complexity, Maximize Efficiency, Minimize Loss). CONCLUSION As external powers continue to apply pressure to surgeon compensation, leaders have had to increasingly focus on clinical productivity, while the missions of research and education become more neglected. One solution could be the development of metrics to best align incentives for clinical, research, and education activities with institutional goals.
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Li X, Evans JM. Incentivizing performance in health care: a rapid review, typology and qualitative study of unintended consequences. BMC Health Serv Res 2022; 22:690. [PMID: 35606747 PMCID: PMC9128153 DOI: 10.1186/s12913-022-08032-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health systems are increasingly implementing policy-driven programs to incentivize performance using contracts, scorecards, rankings, rewards, and penalties. Studies of these "Performance Management" (PM) programs have identified unintended negative consequences. However, no single comprehensive typology of the negative and positive unintended consequences of PM in healthcare exists and most studies of unintended consequences were conducted in England or the United States. The aims of this study were: (1) To develop a comprehensive typology of unintended consequences of PM in healthcare, and (2) To describe multiple stakeholder perspectives of the unintended consequences of PM in cancer and renal care in Ontario, Canada. METHODS We conducted a rapid review of unintended consequences of PM in healthcare (n = 41 papers) to develop a typology of unintended consequences. We then conducted a secondary analysis of data from a qualitative study involving semi-structured interviews with 147 participants involved with or impacted by a PM system used to oversee 40 care delivery networks in Ontario, Canada. Participants included administrators and clinical leads from the networks and the government agency managing the PM system. We undertook a hybrid inductive and deductive coding approach using the typology we developed from the rapid review. RESULTS We present a comprehensive typology of 48 negative and positive unintended consequences of PM in healthcare, including five novel unintended consequences not previously identified or well-described in the literature. The typology is organized into two broad categories: unintended consequences on (1) organizations and providers and on (2) patients and patient care. The most common unintended consequences of PM identified in the literature were measure fixation, tunnel vision, and misrepresentation or gaming, while those most prominent in the qualitative data were administrative burden, insensitivity, reduced morale, and systemic dysfunction. We also found that unintended consequences of PM are often mutually reinforcing. CONCLUSIONS Our comprehensive typology provides a common language for discourse on unintended consequences and supports systematic, comparable analyses of unintended consequences across PM regimes and healthcare systems. Healthcare policymakers and managers can use the results of this study to inform the (re-)design and implementation of evidence-informed PM programs.
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Affiliation(s)
- Xinyu Li
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Jenna M Evans
- DeGroote School of Business, McMaster University, 1280 Main Street West, Hamilton, ON, L8S4M4, Canada.
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Saddi FDC, Forbes LJL, Peckham S. Guest editorial. J Health Organ Manag 2021. [DOI: 10.1108/jhom-05-2021-476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Saddi FDC, Harris M, Parreira FR, Pêgo RA, Coelho GA, Lozano RB, Mundim PDS, Peckham S. Exploring frontliners' knowledge, participation and evaluation in the implementation of a pay-for-performance program (PMAQ) in primary health care in Brazil. J Health Organ Manag 2021. [DOI: 10.1108/jhom-04-2020-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis paper employs implementation theory and the political literature on performance measurement to understand how frontline health workers know, participate and evaluate the Brazilian National Program for Improving Access and Quality of Primary Care (PMAQ, 2nd round).Design/methodology/approachThis paper develops an implementation theory-driven qualitative analysis. The research is developed in the city of Goiania (Brazil): a challenging organizational context in primary care (PHC). Interviews were carried out with 25 frontliners – managers, doctors, nurses and community health workers. Data were thematically and hierarchically analysed according to theoretical concepts such as policy knowledge, policy adherence, forms of accountability, alternative logics, organizational capacity and policy feedback.FindingsResults show the need to foster organizational capacity, knowledge, participation and policy feedback at the frontline. Successful implementation would require those adaptations to counteract policy challenges/failures or the emergence of alternative logics.Research limitations/implicationsThe study was conducted in only one setting, however, our sample includes different types of professionals working in units with different levels of organization capacity, located in distinct HDs, expressing well the implementation of PMAQ/P4P. Qualitative researches need to be developed for further exploring the same/other factors.Social implicationsFindings can be used to improve discussions/planning and design of P4P programs in the city and State of Goias.Originality/valueThe majority of analysis of PMAQ are of a quantitative or results-based nature. This article focuses on politically significant and unanswered questions regarding the implementation of PMAQ.
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Jan CF, Lee MC, Chiu CM, Huang CK, Hwang SJ, Chang CJ, Chiu TY. Awareness of, attitude toward, and willingness to participate in pay for performance programs among family physicians: a cross-sectional study. BMC FAMILY PRACTICE 2020; 21:60. [PMID: 32228473 PMCID: PMC7106702 DOI: 10.1186/s12875-020-01118-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 02/26/2020] [Indexed: 01/02/2023]
Abstract
Background The National Health Insurance Administration of Taiwan has introduced several pay-for-performance programs to improve the quality of healthcare. This study aimed to provide government with evidence-based research findings to help primary care physicians to actively engage in pay-for-performance programs. Methods We conducted a questionnaire survey among family physicians with age-stratified sampling from September 2016 to December 2017. The structured questionnaire consisted of items including the basic demographics of the surveyee and their awareness of and attitudes toward the strengths and/or weaknesses of the pay-for-performance programs, as well as their subjective norms, and the willingness to participate in the pay-for-performance programs. Univariate analysis and multivariate logistic regression analysis were performed to compare the differences between family physicians who participate in the pay-for-performance programs versus those who did not. Results A total of 543 family physicians completed the questionnaire. Among family physicians who participated in the pay-for-performance programs, more had joined the Family Practice Integrated Care Project [Odds ratio (OR): 2.70; 95% Confidence interval (CI): 1.78 ~ 4.09], had a greater awareness of pay-for-performance programs (OR: 2.37; 95% CI: 1.50 ~ 3.83), and a less negative attitude to pay-for-performance programs (OR: 0.50; 95% CI: 0.31 ~ 0.80) after adjusting for age and gender. The major reasons for family physicians who decided to join the pay-for-performance programs included believing the programs help enhance the quality of healthcare (80.8%) and recognizing the benefit of saving health expenditure (63.4%). The causes of unwillingness to join in a pay-for-performance program among non-participants were increased load of administrative works (79.6%) and inadequate understanding of the contents of the pay-for-performance programs (62.9%). Conclusions To better motivate family physicians into P4P participation, hosting effective training programs, developing a more transparent formula for assessing financial risk, providing sufficient budget for healthcare quality improvement, and designing a reasonable profit-sharing plan to promote collaboration between different levels of medical institutions are all imperative.
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Affiliation(s)
- Chyi-Feng Jan
- Department of Family Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No.7, Chung-Shan South Road, 10002, Taipei, Taiwan
| | - Meng-Chih Lee
- Department of Family Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan.,Chinese Taipei (Taiwan) Association of Family Medicine, Taipei, Taiwan
| | - Ching-Ming Chiu
- Department of Family Medicine, National Taiwan University Hospital, Yunlin Branch, Taipei, Yunlin, Taiwan
| | - Cheng-Kuo Huang
- Chinese Taipei (Taiwan) Association of Family Medicine, Taipei, Taiwan.,Keelung Medical Association, Keelung, Taiwan
| | - Shinn-Jang Hwang
- Chinese Taipei (Taiwan) Association of Family Medicine, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Taipei Veterans General Hospital, Taipei, Taiwan
| | - Che-Jui Chang
- Department of Family Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No.7, Chung-Shan South Road, 10002, Taipei, Taiwan
| | - Tai-Yuan Chiu
- Department of Family Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No.7, Chung-Shan South Road, 10002, Taipei, Taiwan. .,Chinese Taipei (Taiwan) Association of Family Medicine, Taipei, Taiwan.
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Saddi FDC, Harris MJ, Coelho GA, Pêgo RA, Parreira F, Pereira W, Santos AKC, Almeida HR, Costa DS. Perceptions and evaluations of front-line health workers regarding the Brazilian National Program for Improving Access and Quality to Primary Care (PMAQ): a mixed-method approach. CAD SAUDE PUBLICA 2018; 34:e00202417. [PMID: 30365749 DOI: 10.1590/0102-311x00202417] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 05/25/2018] [Indexed: 11/22/2022] Open
Abstract
Although it is well known that a successful implementation depends on the front-liners' knowledge and participation, as well as on the organizational capacity of the institutions involved, we still know little about how front-line health workers have been involved in the implementation of the Brazilian National Program for Improving Access and Quality to Primary Care (PMAQ). This paper develops a contingent mixed-method approach to explore the perceptions of front-line health workers - managers, nurses, community health workers, and doctors - regarding the PMAQ (2nd round), and their evaluations concerning health unit organizational capacity. The research is guided by three relevant inter-related concepts from implementation theory: policy knowledge, participation, and organizational capacity. One hundred and twenty-seven health workers from 12 primary health care units in Goiânia, Goiás State, Brazil, answered semi-structured questionnaires, seeking to collect data on reasons for adherence, forms of participation, perceived impact (open-ended questions), and evaluation of organizational capacity (score between 0-10). Content analyses of qualitative data enabled us to categorize the variables "level of perceived impact of PMAQ" and "reasons for adhering to PMAQ". The calculation and aggregation of the means for the scores given for organizational capacity enabled us to classify distinct levels of organizational capacity. We finally integrated both variables (Perceived-Impact and Organizational-Capacity) through cross-tabulation and the narrative. Results show that nurses are the main type of professional participating. The low organizational capacity and little policy knowledge affected workers participation in and their perceptions of the PMAQ.
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Affiliation(s)
- Fabiana da Cunha Saddi
- Faculdade de Ciências Sociais, Universidade Federal de Goiás, Goiânia, Brasil.,Centre for Health Services Studies, University of Kent, Canterbury, U.K
| | | | | | | | - Fernanda Parreira
- Faculdade de Ciências Sociais, Universidade Federal de Goiás, Goiânia, Brasil
| | - Wellida Pereira
- Faculdade de Ciências Sociais, Universidade Federal de Goiás, Goiânia, Brasil
| | | | - Heloany R Almeida
- Faculdade de Ciências Sociais, Universidade Federal de Goiás, Goiânia, Brasil
| | - Douglas S Costa
- Faculdade de Ciências Sociais, Universidade Federal de Goiás, Goiânia, Brasil
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Brazilian Payment for Performance (PMAQ) Seen From a Global Health and Public Policy Perspective: What Does It Mean for Research and Policy? J Ambul Care Manage 2018; 41:25-33. [PMID: 28990991 DOI: 10.1097/jac.0000000000000220] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This supplement of the Journal of Ambulatory Care Management on the Brazilian National Program for Improving Access and Quality of Primary Care (PMAQ) reveals a relevant gap in the Brazilian literature on pay for performance/PMAQ, and is therefore an opportunity to bring contributions from global health and public policy to the debate. We discuss the relevant gap in the light of developments in evaluation and policy analysis. We afterward present the state of knowledge regarding global health and public policy in pay for performance, giving attention to diverse themes, methods, types of analyses, theoretical contributions, and limitations. Finally, we suggest some possible implications for research and policy in Brazil.
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Vokes RA, Bearman G, Bazzoli GJ. Hospital-Acquired Infections Under Pay-for-Performance Systems: an Administrative Perspective on Management and Change. Curr Infect Dis Rep 2018; 20:35. [PMID: 30051191 DOI: 10.1007/s11908-018-0638-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to explore the impact of hospital-acquired infection on payment under pay-for-performance systems, and provide perspective on the role of administrators in infection prevention. RECENT FINDINGS Hospital-acquired infections continue to pose a serious threat to patient safety and to the fiscal viability of healthcare facilities under pay-for-performance systems. There is mixed evidence that use of pay-for-performance systems leads to prevention of hospital-acquired conditions. Use of evidence-based guidelines has been shown to reduce hospital-acquired infections. Increasing use of pay-for-performance (PFP) systems results in potential loss of reimbursement for healthcare organizations that fail to prevent hospital-acquired infections (HAI). Healthcare administrators must work with front-line providers and infection control staff to establish and maintain evidence-based infection prevention policy. Additionally, infection control policy should be regularly updated to reflect best practices, and proper change management techniques should be employed in order to mobilize and empower staff to increase their ability to prevent hospital-acquired infections.
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Affiliation(s)
- Rebecca A Vokes
- Department of Health Administration, Virginia Commonwealth University, Richmond, VA, USA.
| | | | - Gloria J Bazzoli
- Department of Health Administration, Virginia Commonwealth University, Richmond, VA, USA
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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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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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Ju Kim S, Han KT, Kim SJ, Park EC. Pay-for-performance reduces healthcare spending and improves quality of care: Analysis of target and non-target obstetrics and gynecology surgeries. Int J Qual Health Care 2017; 29:222-227. [PMID: 28407094 DOI: 10.1093/intqhc/mzw159] [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: 07/20/2016] [Accepted: 04/11/2017] [Indexed: 01/15/2023] Open
Abstract
Objective In Korea, the Value Incentive Program (VIP) was first applied to selected clinical conditions in 2007 to evaluate the performance of medical institutes. We examined whether the condition-specific performance of the VIP resulted in measurable improvement in quality of care and in reduced medical costs. Design Population-based retrospective observational study. Setting We used two data set including the results of quality assessment and hospitalization data from National Health Claim data from 2011 to 2014. Participants Participants who were admitted to the hospital for obstetrics and gynecology were included. A total of 535 289 hospitalizations were included in our analysis. Methods We used a generalized estimating equation (GEE) model to identify associations between the quality assessment and length of stay (LOS). A GEE model based on a gamma distribution was used to evaluate medical cost. The Poisson regression analysis was used to evaluate readmission. Main Outcome Measures The outcome variables included LOS, medical costs and readmission within 30 days. Results Higher condition-specific performance by VIP participants was associated with shorter LOSs, decreases in medical cost, and lower within 30-day readmission rates for target and non-target surgeries. LOS and readmission within 30 days were different by change in quality assessment at each medical institute. Conclusions Our findings contribute to the body of evidence used by policy-makers for expansion and development of the VIP. The study revealed the positive effects of quality assessment on quality of care. To reduce the between-institute quality gap, alternative strategies are needed for medical institutes that had low performance.
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Affiliation(s)
- Seung Ju Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Kyu-Tae Han
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Sun Jung Kim
- Department of Health Administration, Soonchunhyang University, Chungnam, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Liu T, Asch DA, Volpp KG, Zhu J, Wang W, Troxel AB, Adejare A, Finnerty DD, Hoffer K, Shea JA. Physician attitudes toward participating in a financial incentive program for LDL reduction are associated with patient outcomes. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2016; 5:119-124. [PMID: 27932264 DOI: 10.1016/j.hjdsi.2016.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 08/03/2016] [Accepted: 09/14/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Tianyu Liu
- University of Pennsylvania, Philadelphia, PA, USA
| | - David A Asch
- University of Pennsylvania, Philadelphia, PA, USA; Department of Veterans Affairs, Philadelphia, PA, USA
| | - Kevin G Volpp
- University of Pennsylvania, Philadelphia, PA, USA; Department of Veterans Affairs, Philadelphia, PA, USA
| | - Jingsan Zhu
- University of Pennsylvania, Philadelphia, PA, USA
| | - Wenli Wang
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - Karen Hoffer
- University of Pennsylvania, Philadelphia, PA, USA
| | - Judy A Shea
- University of Pennsylvania, Philadelphia, PA, USA.
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Does Pay-For-Performance Program Increase Providers Adherence to Guidelines for Managing Hepatitis B and Hepatitis C Virus Infection in Taiwan? PLoS One 2016; 11:e0161002. [PMID: 27517172 PMCID: PMC4982614 DOI: 10.1371/journal.pone.0161002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/28/2016] [Indexed: 02/07/2023] Open
Abstract
Background Many people are concerned about that the quality of preventive care for patients with hepatitis B virus (HBV) and hepatitis C virus (HCV) infection is suboptimal. Taiwan, a hyperendemic area of chronic HBV and HCV infection, implemented a nationwide pay-for-performance (P4P) program in 2010, which aimed to improve the preventive care provided to HBV and HCV patients by increasing physicians’ adherence to guidelines through financial incentives. The objective of this study was to evaluate the early effects of the P4P program on utilization of preventive services by HBV and HCV patients. Methods Using a quasi-experimental design with propensity score matching method, we matched the HBV and HCV patients enrolled in the P4P program with non-enrollees in 2010, resulting in 21,643 patients in each group. Generalized estimating equations was applied to examine the difference-in-difference effects of P4P program enrollment on the utilization of three guideline-recommended preventive services (regular outpatient follow-up visits, abdominal ultrasonography (US) examinations, and aspartate aminotransferase and alanine aminotransferase (AST/ALT) tests by HBV and HCV patients. Results The P4P program enrollees were significantly more likely to attend twice-annual follow-up visits, to receive recommended US examinations and AST/ALT tests, than non-enrollees. Conclusions The results of our preliminary assessment indicate that financial incentives offered by the P4P program was associated with a modest improvement in adherence to guidelines for better chronic HBV and HBC management.
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Krauth C, Liersch S, Jensen S, Amelung VE. Would German physicians opt for pay-for-performance programs? A willingness-to-accept experiment in a large general practitioners' sample. Health Policy 2016; 120:148-58. [PMID: 26852868 DOI: 10.1016/j.healthpol.2016.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 01/06/2016] [Accepted: 01/07/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Implementing pay-for-performance (P4P) programs is a non-trivial task. As evaluation studies showed, P4P programs often failed to improve performance quality. A crucial element for the successful implementation of P4P is to gain acceptance with health care providers. OBJECTIVES The aim of our study was to determine, if (and at what bonus rate) German general practitioners (GPs) would participate in a P4P program. We further examined differences between respondents who would participate in a P4P program (participants) versus respondents who would not participate (non-participants). METHODS A mail survey was conducted among 2493 general practitioners (GPs) in Lower Saxony (with a response rate of 36.2%). The questionnaire addressed attitudes toward P4P and included a willingness to accept experiment concerning P4P implementation. RESULTS The participation rate increased from 28% (at a bonus of 2.5%) to 50% (at a bonus of 20%). Participants showed better performance in target achievement and expected higher gains from P4P than non-participants. Major attitude differences were found in assessing feasibility of P4P, incentivizing performance and unintended consequences. The crucial factor for (not) accepting P4P might be the sense of (un)fairness of P4P. CONCLUSION To convince GPs to participate in P4P, better evidence for the effectiveness of P4P is required. To address the concerns of GPs, future endeavors should be directed to tailoring P4P programs. Finally, program implementation must be well communicated and thoroughly discussed with health care providers.
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Affiliation(s)
- Christian Krauth
- Hannover Medical School, Center for Health Economics Research Hannover (CHERH), Carl-Neuberg-St. 1, 30625 Hanover, Germany.
| | - Sebastian Liersch
- Hannover Medical School, Center for Health Economics Research Hannover (CHERH), Carl-Neuberg-St. 1, 30625 Hanover, Germany
| | - Sören Jensen
- Hannover Medical School, Center for Health Economics Research Hannover (CHERH), Carl-Neuberg-St. 1, 30625 Hanover, Germany
| | - Volker Eric Amelung
- Hannover Medical School, Center for Health Economics Research Hannover (CHERH), Carl-Neuberg-St. 1, 30625 Hanover, Germany
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Barreto JOM. [Pay-for-performance in health care services: a review of the best evidence available]. CIENCIA & SAUDE COLETIVA 2015; 20:1497-514. [PMID: 26017951 DOI: 10.1590/1413-81232015205.01652014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 06/17/2014] [Indexed: 11/22/2022] Open
Abstract
Pay-for-performance (P4P) has been widely used around the world seeking to improve health outcomes, and in Brazil it is the basis of the National Program for Improving Access and Quality (PMAQ). The literature published between 1998 and January 2013 that evaluated the effectiveness of P4P to produce results or patterns of access and quality in health was scrutinized. A total of 138 studies, with the inclusion of a further 41 studies (14 systematic reviews, 07 clinical trials and 20 observational studies) were retrieved and analyzed Among the more rigorous studies, favorable conclusions for P4P were less frequent, whereas observational studies were more favorable to positive effects of P4P on the quality of, and access to, health services. Methodological limitations of observational studies may have contributed to these results, but the range of results is more linked to the conceptual and contextual aspects of the use of the P4P schemes reviewed, the heterogeneity of P4P models and results. P4P can be helpful in promoting the achievement of objectives in health care systems, especially in the short term and for specific actions requiring less effort of health care providers, but should be used with caution and with a rigorous planning model, also considering undesirable or adverse effects.
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Yuzden GE, Yildirim J. A Qualitative Evaluation of the Performance-based Supplementary Payment System in Turkey. JOURNAL OF HEALTH MANAGEMENT 2014. [DOI: 10.1177/0972063414526114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Ministry of Health of Turkey introduced performance-based supplementary payment (PBSP) system in 2004. The importance of feedbacks from healthcare providers regarding the implementation of alternative health policies has been recognized in the literature. This study reports the perceptions of physicians about the PBSP system in Turkey. A qualitative analysis has been conducted in two hospitals in the Western province of Turkey, Balıkesir. Analysis results suggest that physicians have limited awareness about the pay for performance system. They agree that the PBSP system has not achieved the objectives of enhancing productivity, efficiency and quality of care. The major contributing factors to the limited success of the system have been identified as increased workload, stress and competition among the physicians. Thus revisions have been suggested for the proper implementation of the programme, which include the determination of a maximum number of medical examinations.
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Chimhutu V, Lindkvist I, Lange S. When incentives work too well: locally implemented pay for performance (P4P) and adverse sanctions towards home birth in Tanzania - a qualitative study. BMC Health Serv Res 2014; 14:23. [PMID: 24438556 PMCID: PMC3897973 DOI: 10.1186/1472-6963-14-23] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 01/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite limited evidence of its effectiveness, performance-based payments (P4P) are seen by leading policymakers as a potential solution to the slow progress in reaching Millennium Development Goal 5: improved maternal health. This paper offers insights into two of the aspects that are lacking in the current literature on P4P, namely what strategies health workers employ to reach set targets, and how the intervention plays out when implemented by local government as part of a national programme that does not receive donor funding. METHODS A total of 28 in-depth interviews (IDIs) with 25 individuals were conducted in Mvomero district over a period of 15 months in 2010 and 2011, both before and after P4P payments. Seven facilities, including six dispensaries and one health centre, were covered. Informants included 17 nurses, three clinical officers, two medical attendants, one lab technician and two district health administrators. RESULTS Health workers reported a number of strategies to increase the number of deliveries at their facility, including health education and cooperation with traditional health providers. The staff at all facilities also reported that they had told the women that they would be sanctioned if they gave birth at home, such as being fined or denied clinical cards and/or vaccinations for their babies. There is a great uncertainty in relation to the potential health impacts of the behavioural changes that have come with P4P, as the reported strategies may increase the numbers, but not necessarily the quality. Contrary to the design of the P4P programme, payments were not based on performance. We argue that this was due in part to a lack of resources within the District Administration, and in part as a result of egalitarian fairness principles. CONCLUSIONS Our results suggest that particular attention should be paid to adverse effects when using external rewards for improved health outcomes, and secondly, that P4P may take on a different form when implemented by local implementers without the assistance of professional P4P specialists.
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Affiliation(s)
- Victor Chimhutu
- Department of Health Promotion and Development (HEMIL), University of Bergen, P,O, Box 7807, Bergen 5020, Norway.
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Tchoe B, Lee S. The Possibility of Expanding Pay-for-Performance Program as a Provider Payment System. HEALTH POLICY AND MANAGEMENT 2013. [DOI: 10.4332/kjhpa.2013.23.1.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Wang Y, Wei S, Li Y, Deng S, Luo Q, Li Y. Challenges and a response strategy for the development of nursing in China: a descriptive and quantitative analysis. J Evid Based Med 2013; 6:21-33. [PMID: 23557525 DOI: 10.1111/jebm.12016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 12/23/2012] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess the challenges to and provide a response strategy for the development of nursing and make suggestions for promoting the nursing discipline, platform, and talent teams based on current best available evidence. METHODS We searched CNKI(China National Knowledge Infrastructure), VIP information(Chinese Scientific Journals database), CBM(Chinese Biomedical Literature database), and Web sites of the World Health Organization, International Council of Nurses, World Bank, the Ministry of Health and the Ministry of Education of China, and relevant schools in China. Data analyses were performed using SPSS 13.0. RESULTS We identified 886 nursing schools in China in 2012. Results showed that 38,212 nursing students were enrolled in universities or independent colleges and 130,837 nursing student were enrolled in colleges or senior vocational schools. The doctor-to-nurse ratio was 1:0.9 in 2010. The actual demand for doctors was 2.6 million, whereas the nursing shortage was approximately 346,000. Nurses aged ≤ 35 years accounted for 50% of the total. A total of 64% to 69% of nurses had primary professional titles; fewer than 2.5% of those had advanced titles. The training costs for one doctor or one nurse in China was only two-fifths that in India and one-fifth to one-fourth that in sub-Saharan Africa. To date, only 30.1% of disaster nursing studies in China provided research data; 30.6% were related to clinical experience and 38.3% were reviews. CONCLUSIONS Education and health systems need to be extensively reformed. It is necessary to train nursing students with core competencies using transformative learning. It is necessary to update textbooks and teaching methods, and funding should be appropriately increased. Nursing should co-operate with other disciplines, and apply evidence-based nursing methods to improve the quality of healthcare services and patient satisfaction.
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Affiliation(s)
- Yingqiang Wang
- Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Shiyou Wei
- West China Medical School, Sichuan University, Chengdu, China
| | - Youping Li
- Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Shaolin Deng
- Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu, China
- West China Medical School, Sichuan University, Chengdu, China
- West China Hospital, Sichuan University, Chengdu, China
| | - Qianqian Luo
- National Chengdu Center for Safety Evaluation of Drugs, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Li
- Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu, China
- School of Political Science, Sichuan University, Chengdu, China
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