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Results for “Reimbursement, Incentive”

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PubMed2001

A positive analysis of financial incentives for cadaveric organ donation.

Financial incentives of various kinds have been suggested to alleviate the chronic shortage of transplantable organs in the United States. This paper analyzes the possible consequences of financial incentives on organ supply. We show that under current practice and current law (which are not the same), inducements to donate organs or to register as an organ donor may lead to a decline in the supply of organs. Furthermore, some financial incentives that have been proposed lead to time inconsistent choices.

Cadaver↗
PubMed2005

Quality-based payment: six case examples.

INTRODUCTION: The logic of paying more for high-quality care and less for low-quality resonates. Increasingly health system leaders worldwide acknowledge that payment reforms are needed to do just that, prompted no doubt by the growing body of evidence indicating that quality is not what it should be. PURPOSE: This review was undertaken to explore contexts in which quality-based payment appears feasible. The ultimate intent is to provoke thoughtful debate about whether and how quality-based payment might fit within a particular developing country's framework of policies to ensure and promote quality of care. METHODS: With guidance from key informants with first-hand knowledge of international quality-based payment schemes, a purposive sample of six quality-based payment schemes was assembled. Schemes were examined to identify environmental contexts and design features. RESULTS: Examples illustrate a variety of approaches and a breadth of contexts in which quality-based payment has been implemented. Contrary to what might be expected, implementation does not appear to be constrained to private-sector purchasers, private-sector providers, hospital settings, nor to any particular type of underlying payment system. Further, quality-based payment pioneers are using a variety of incentive structures, and are tapping a rich mix of structural, process, and outcome standards to benchmark quality. CONCLUSION: Despite significant operational challenges, quality-based payment has been implemented in developing as well as developed countries, albeit not frequently in either instance. What we do not know--what the literature is nearly silent on--relates to the sustainability and ultimate impact of alternative incentive schemes.

Benchmarking↗
PubMed1998

Primary care physicians' experience of financial incentives in managed-care systems.

BACKGROUND: Managed-care organizations' use of financial incentives to influence the practice of primary care physicians is controversial. We studied the prevalence and effects of these incentives. METHODS: We surveyed a probability sample of primary care physicians practicing in the largest urban counties in California in 1996. The physicians were asked about the types of incentives they encountered, the amount of income that was keyed to incentives, their experience of pressure in their practices, and the ways in which such pressure affected patient care. RESULTS: Data were analyzed for 766 physicians involved in managed-care systems. Thirty-eight percent of these physicians reported that their arrangements with the managed-care system included some type of incentive in the form of a bonus. Fifty-seven percent of the physicians reported that they felt pressure from the managed-care organization to limit referrals (17 percent said they believed such pressure compromised patient care), and 75 percent felt pressure to see more patients per day (24 percent believed such pressure compromised patient care). The physicians who reported that their financial arrangements included an incentive based on referrals were more likely than others to have felt pressured to limit referrals in a manner that compromised care (adjusted odds ratio 2.5; 95 percent confidence interval, 1.2 to 5.0), and physicians with an incentive based on productivity were more likely to have felt pressure to see more patients that they believed compromised care (adjusted odds ratio, 2.1; 95 percent confidence interval, 1.2 to 3.8). The physicians whose health care systems used incentives keyed to productivity were less likely than others to be very satisfied with their practices (adjusted odds ratio, 0.4; 95 percent confidence interval, 0.2 to 0.6), whereas those whose systems included incentives related to the quality of care or patients' satisfaction were more likely to be very satisfied (adjusted odds ratio, 1.8; 95 percent confidence interval, 1.1 to 3.0). CONCLUSIONS: Many managed-care organizations include financial incentives for primary care physicians that are indexed to various measures of performance. Incentives that depend on limiting referrals or on greater productivity apply selective pressure to physicians in ways that are believed to compromise care. Incentives that depend on the quality of care and patients' satisfaction are associated with greater job satisfaction among physicians.

Attitude of Health Personnel↗
PubMed2006

Incentive implementation in physician practices: A qualitative study of practice executive perspectives on pay for performance.

Pay-for-performance (P4P) programs offer health care providers financial incentives to achieve predefined quality targets. Practice executives sit at a key nexus point for determining how P4P programs are implemented in physician practices. Using a qualitative interview design, this article examines the role practice executives play in the implementation of P4P programs and how their perspectives and decisions can influence the success of these programs. The authors identified five key findings related to practice executives' views on P4P: quality incentives are better than utilization incentives, quality incentives are bonus rewards, quality incentives are agents for change, providers do not feel they have control over attaining quality targets, and the ways in which quality is measured are problematic. The authors discuss five different ways in which practice executives distribute rewards to physicians. These findings may help payers more effectively design and implement financial rewards for quality.

Attitude of Health Personnel↗
PubMed2004

Will changes in primary care improve health outcomes? Modelling the impact of financial incentives introduced to improve quality of care in the UK.

OBJECTIVES: To estimate the total health gain from improving the quality of care among patients with cardiovascular disease in line with the quality indicator targets in the new contract for general practitioners (GPs) in the UK. DESIGN: Statistical modelling, applying population impact measures to estimate cardiovascular health gains from achieving treatment targets in the GP contract, taking into account current levels of treatment and control. MAIN OUTCOME MEASURES: Number of events prevented in the population over 5 years applied to a national general practice population of 10,000. RESULTS: The greatest health gain in those aged 45-84 years would come from reaching cholesterol reduction targets. This could prevent 15 events in people with coronary heart disease, seven events in those with a history of stroke, and seven events in those with diabetes. Achieving blood pressure control targets in hypertensive patients without the above conditions could prevent 15 cardiovascular events, with further benefits from reducing blood pressure in patients with high blood pressure and coronary heart disease, stroke, or diabetes. Achieving other targets would have smaller impacts because high levels of care are already being achieved or because of the low prevalence of conditions or associated event risk. CONCLUSION: It is possible to quantify the health gain to a practice population of achieving quality targets such as those set in the new GP contract. The amount of health gain is sensitive to current quality of care, prevalence of conditions, and risk factors, and to the size of change anticipated. Nevertheless, it appears that significant health gains could result from achieving the proposed quality targets.

Aged↗
PubMed2006

What's the return? Assessing the effect of "pay-for-performance" initiatives on the quality of care delivery.

This article evaluates the impact of the Centers for Medicare & Medicaid Services/Premier pay-for-performance demonstration project on performance improvement in three clinical areas in a multihospital health care system. The study compares a group of hospitals participating in this project against a control group of similar hospitals that did not participate. Although the incentives are extremely small, the findings show that participation in the pay-for-performance initiative had a significant impact on the rate and magnitude of performance improvement. The project led to marked improvement in the quality of clinical process delivery and accelerated the adoption of evidence-based practices.

Catholicism↗