 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| ||||||||||||||||||||||||||||||||||||||||||||||
15 August 2006 | Volume 145 Issue 4 | Pages 265-272
Background: Most physicians and hospitals are paid the same regardless of the quality of the health care they provide. This produces no financial incentives and, in some cases, produces disincentives for quality. Increasing numbers of programs link payment to performance.
Purpose: To systematically review studies assessing the effect of explicit financial incentives for improved performance on measures of health care quality.
Data Sources: PubMed search of English-language literature (1 January 1980 to 14 November 2005), and reference lists of retrieved articles.
Study Selection: Empirical studies of the relationship between explicit financial incentives designed to improve health care quality and a quantitative measure of health care quality.
Data Extraction: The authors categorized studies according to the level of the incentive (individual physician, provider group, or health care payment system) and the type of quality measure rewarded.
Data Synthesis: Thirteen of 17 studies examined process-of-care quality measures, most of which were for preventive services. Five of the 6 studies of physician-level financial incentives and 7 of the 9 studies of provider group-level financial incentives found partial or positive effects on measures of quality. One of the 2 studies of incentives at the payment-system level found a positive effect on access to care, and 1 showed evidence of a negative effect on access to care for the sickest patients. In all, 4 studies suggested unintended effects of incentives. The authors found no studies examining the optimal duration of financial incentives for quality or the persistence of their effects after termination. Only 1 study addressed cost-effectiveness.
Limitations: Few empirical studies of explicit financial incentives for quality were available for review.
Conclusions: Ongoing monitoring of incentive programs is critical to determine the effectiveness of financial incentives and their possible unintended effects on quality of care. Further research is needed to guide implementation of financial incentives and to assess their cost-effectiveness.
Author and Article Information
From Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas.
Disclaimer: The views expressed in this article are solely the authors' and do not necessarily represent those of the Veterans Administration.
Grant Support: In part by VA HSR&D IIR 04-349 (Dr. Petersen, Principal Investigator) and NIH RO1 HL079173-01 (Dr. Petersen, Principal Investigator). Dr. Petersen is a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar (grant no. 045444) and a recipient of the American Heart Association Established Investigator Award (grant no. 0540043N).
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Laura A. Petersen, MD, MPH, Health Services Research and Development (152), Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030; e-mail, laurap{at}bcm.edu.
Current Author Addresses: Drs. Petersen and Woodard, Ms. Daw, and Ms. Sookanan: Health Services Research and Development (152), Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX, 77030.
Ms. Urech: VA Boston Health Care System—Jamaica Plain Campus, 150 South Huntington Avenue, Jamaica Plain, MA 02130. IMPROVING PATIENT CARE
Improving Patient Care is a special section within Annals supported in part by the U.S. Department of Health and Human Services (HHS) Agency for Healthcare Research and Quality (AHRQ). The opinions expressed in this article are those of the authors and do not represent the position or endorsement of AHRQ or HHS.
Does Pay-for-Performance Improve the Quality of Health Care?
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  S. M. O'Brien, E. R. DeLong, and E. D. Peterson Impact of Case Volume on Hospital Performance Assessment Arch Intern Med, June 23, 2008; 168(12): 1277 - 1284. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. De Costa, E. Johansson, and V. K. Diwan Barriers of Mistrust: Public and Private Health Sectors' Perceptions of Each Other in Madhya Pradesh, India Qual Health Res, June 1, 2008; 18(6): 756 - 766. [Abstract] [PDF]
|
|
|
|
 |
|
 S. M. Campbell, R. McDonald, and H. Lester The Experience of Pay for Performance in English Family Practice: A Qualitative Study Ann. Fam. Med, May 1, 2008; 6(3): 228 - 234. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. R. Frieden and F. Mostashari Health Care as If Health Mattered JAMA, February 27, 2008; 299(8): 950 - 952. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Mannion and H. T O Davies Payment for performance in health care BMJ, February 9, 2008; 336(7639): 306 - 308. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Snyder, R. L. Neubauer, and for the American College of Physicians Ethics, Pro Pay-for-Performance Principles That Promote Patient-Centered Care: An Ethics Manifesto Ann Intern Med, December 4, 2007; 147(11): 792 - 794. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. B Wilson, B. E Landon, P. V Marsden, L. R Hirschhorn, K. McInnes, L. Ding, and P. D Cleary Correlations among measures of quality in HIV care in the United States: cross sectional study BMJ, November 24, 2007; 335(7629): 1085 - 1085. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. B. Rosenthal, B. E. Landon, K. Howitt, H. R. Song, and A. M. Epstein Climbing Up The Pay-For-Performance Learning Curve: Where Are The Early Adopters Now? Health Aff., November 1, 2007; 26(6): 1674 - 1682. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Biai, A. Rodrigues, M. Gomes, I. Ribeiro, M. Sodemann, F. Alves, and P. Aaby Reduced in-hospital mortality after improved management of children under 5 years admitted to hospital with malaria: randomised trial BMJ, October 27, 2007; 335(7625): 862 - 862. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. P. Wodchis, J. S. Ross, and A. S. Detsky Is P4P Really FFS? JAMA, October 17, 2007; 298(15): 1797 - 1799. [Full Text] [PDF]
|
|
|
|
 |
|
 A. T. Chien, M. H. Chin, A. M. Davis, and L. P. Casalino Pay for Performance, Public Reporting, and Racial Disparities in Health Care: How Are Programs Being Designed? Med Care Res Rev, October 1, 2007; 64(5_suppl): 283S - 304S. [Abstract] [PDF]
|
|
|
|
 |
|
 A. A. Desai, A. M. Garber, and G. M. Chertow Rise of Pay for Performance: Implications for Care of People with Chronic Kidney Disease Clin. J. Am. Soc. Nephrol., September 1, 2007; 2(5): 1087 - 1095. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Mangin, K. Sweeney, and I. Heath Preventive health care in elderly people needs rethinking BMJ, August 11, 2007; 335(7614): 285 - 287. [Full Text] [PDF]
|
|
|
|
|
|
S. M. Shortell, T. G. Rundall, and J. Hsu Improving Patient Care by Linking Evidence-Based Medicine and Evidence-Based Management JAMA, August 8, 2007; 298(6): 673 - 676. [Full Text] [PDF]
|
|
|
|
 |
|
 M. H. Anderson Dentistry and Dental Education in the Context of the Evolving Health Care System J Dent Educ., August 1, 2007; 71(8): 988 - 993. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. R. Tonelli Conflict of Interest in Clinical Practice Chest, August 1, 2007; 132(2): 664 - 670. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. E. Mandel and U. R. Kotagal Pay for Performance Alone Cannot Drive Quality Arch Pediatr Adolesc Med, July 1, 2007; 161(7): 650 - 655. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Profit and L. A. Petersen Pay for Performance Is Growing Up Arch Pediatr Adolesc Med, July 1, 2007; 161(7): 713 - 714. [Full Text] [PDF]
|
|
|
|
|
|
C. J. Homer For Love, for Money, or for Both?: Which Way Will We Choose to Transform Children's Health Care? Arch Pediatr Adolesc Med, July 1, 2007; 161(7): 715 - 717. [Full Text] [PDF]
|
|
|
|
 |
|
 A. T. Chien and R. A. Dudley Pay-for-Performance in Pediatrics: Proceed With Caution Pediatrics, July 1, 2007; 120(1): 186 - 188. [Full Text] [PDF]
|
|
|
|
|
|
S. W. Glickman, F.-S. Ou, E. R. DeLong, M. T. Roe, B. L. Lytle, J. Mulgund, J. S. Rumsfeld, W. B. Gibler, E. M. Ohman, K. A. Schulman, et al. Pay for Performance, Quality of Care, and Outcomes in Acute Myocardial Infarction JAMA, June 6, 2007; 297(21): 2373 - 2380. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Millett, J. Gray, S. Saxena, G. Netuveli, and A. Majeed Impact of a pay-for-performance incentive on support for smoking cessation and on smoking prevalence among people with diabetes Can. Med. Assoc. J., June 5, 2007; 176(12): 1705 - 1710. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M. Bell and W. Levinson Pay for performance: learning about quality Can. Med. Assoc. J., June 5, 2007; 176(12): 1717 - 1719. [Full Text] [PDF]
|
|
|
|
|
|
J. Profit, J. A. F. Zupancic, J. B. Gould, and L. A. Petersen Implementing Pay-for-Performance in the Neonatal Intensive Care Unit Pediatrics, May 1, 2007; 119(5): 975 - 982. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Van Swol Does Pay-for-Performance Improve the Quality of Health Care? Ann Intern Med, April 3, 2007; 146(7): 538 - 538. [Full Text] [PDF]
|
|
|
|
 |
|
 E. B. Milbrandt, A. Ishizaka, and D. C. Angus Update in Critical Care 2006 Am. J. Respir. Crit. Care Med., April 1, 2007; 175(7): 638 - 648. [Full Text] [PDF]
|
|
|
|
|
|
B. L. Sapers The Promotion of Gabapentin Ann Intern Med, February 20, 2007; 146(4): 313 - 313. [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Epstein Pay for Performance at the Tipping Point N. Engl. J. Med., February 1, 2007; 356(5): 515 - 517. [Full Text] [PDF]
|
|
|
|
|
|
H. B. El-Serag, L. Petersen, H. Hampel, P. Richardson, and G. Cooper The use of screening colonoscopy for patients cared for by the department of veterans affairs. Arch Intern Med, November 13, 2006; 166(20): 2202 - 2208. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Paying for Performance Can Improve Quality of Care Journal Watch (General), September 19, 2006; 2006(919): 1 - 1. [Full Text]
|
|
|
|
|
|
K. Fister What's new in the other general journals BMJ, September 2, 2006; 333(7566): 490 - 490. [Full Text] [PDF]
|
|
Read all Rapid Responses
Article
