This latest update from the Primary Health Care Research and Information Service looks at what incentives are offered around the world and how effective they are. They conclude:
Incentives on their own are not sufficient to impact on care provision without both appropriate infrastructure and the engagement of general practice.
Jodie Oliver-Baxter, Lynsey Brown, Melissa Raven and Petra Bywood write:
In this post-budget period there has been much emphasis on financing and general practice in Australia. With the introduction of a patient contribution fee, quality of care in general practice will become even more scrutinised by the consumer, making improvements to services not only a moral, but financial imperative for all GPs.
This Policy Issue Review: ‘Quality improvement financial incentives for general practitioners’ from the Primary Health Care Research & Information Service (PHCRIS) looks at Quality Improvement programs with attached financial incentives in Australia, the United Kingdom, United States, Canada and New Zealand since 2009. Worldwide there has been a trend toward recording, measuring and financially rewarding the quality of care in general practice as a means to address inequities and improve patient safety.
Quality improvement approaches refer to aspects of self-reflection and benchmarking, with continued evaluation, to identify where additional improvements to practice can be made. Measures of the quality of care are typically: structure (for example, related to an organisation’s operations), process (for example, clinical guidelines or care pathways), or outcomes-based (for example, physiological indicators).
Improvements can be measured in relative or absolute terms. The likelihood of engaging with incentives and the behavioural responses of health professionals are affected by the different characteristics of financial incentives.
For example, financial incentives may be directed at networks of practices, individual practices, or specific health care professionals. Payments may be offered as a bonus or addition to usual earnings, or may be withheld if practices do not achieve desired outcomes. Payments may be prospective or retrospective and may be linked to fixed thresholds or individual patients.
Currently, the Australian health system relies on a mixed funding model with a focus on fee-for-service, which does not actively reward quality of care.
Blended models, which include financial incentives, such as current Practice Incentive Payments (PIP) for diabetes and cervical cancer screening, have been proposed by the Australian Government to further encourage improvements in the quality and safety of health care provided.
This report reviews international information and evidence from the Quality Outcomes Framework (UK), the Physician Quality Reporting System (US), the Health Council of Canada and the New Zealand Health Quality and Safety Commission.
The increasing metrification of health care delivery has resulted in enormous investment by governments worldwide; however financial incentives, like pay-for-performance, approaches to quality improvement in general practices have yielded mixed findings. Incentives on their own are not sufficient to impact on care provision without both appropriate infrastructure and the engagement of general practice.
You can access this issue of Policy Issue Review: ‘Quality improvement financial incentives for general practitioners’ at the PHCRIS website and be the first to add your comment.
This PHCRIS publication featured in the 22nd May 2014 edition of PHCRIS eBulletin, available at phcris.org.au/ebulletin. The eBulletin is designed to inform readers of recently published articles and reports, news items, media releases, upcoming conferences and courses, research grants, scholarships and fellowships, PHC RIS products and services and relevant websites in the primary health care field. Those interested in receiving the weekly eBulletin are invited to subscribe to this free service.