An Analysis of Pay-for-Performance Schemes and Their Potential Impacts on Health Systems and Outcomes for Patients

Abstract

Pay-for-performance (P4P) programs have been introduced into the Canadian medical system in the last decades. This paper examines the underlying characteristics of P4P and describes both their advantages and drawbacks. Most P4P programs provide the advantage of rewarding medical acts, thus providing an incentive to take on complex patients. There is a variety of nuanced P4P initiatives, which provide financial incentive according to differing criteria, based on quality measures, incentives, and/or benchmark structures. However, there is no conclusive evidence demonstrating that P4P programs provide better value for money than traditional pay schemes, regardless of particular structural choices. Some evidence has even shown that P4P may be detrimental, especially in disadvantaged and high-risk populations. Additionally, there are a number of ethical and practical concerns that arise with the use of P4P, such as the risk of financial incentives being misused or misinterpreted and patients being refused or referred during treatment. P4P initiatives require careful examination and the creation of solid, evidence-based criteria for evaluation and implementation in Canadian medical systems.

Does pay-for-performance improve patient outcomes in acute exacerbation of COPD admissions?

“…The value of pay-for-performance schemes has been investigated in other healthcare settings; [6][7][8] however, it is difficult to draw direct comparisons given differences in healthcare delivery and pay-for-performance models that exist. While financial incentives are often seen as being a key element in changing clinical practice, pay-for-performance does not always lead to better easily measurable outcomes.…”

“…5 Pay-for-performance incentives exist in several countries and for several diseases. [6][7][8] In England, optimal care of AECOPD admissions has been incentivised since 2017 through the COPD Best Practice Tariff (BPT), which encourages best practice by paying care providers an additional amount for AECOPD admissions that are (1) reviewed by a respiratory specialist within 24 hours of the admission and (2) receive a discharge care bundle before the patient leaves hospital. A care bundle is a collection of evidence-based interventions.…”

Adding Pay-for-Performance Program to Routine Care Was Related to a Lower Risk of Depression Among Type 2 Diabetes Patients in Taiwan

“…We suggest several potential reasons for the beneficial effect of P4P on depression risk in this study. First, a unique difference between the P4P program and conventional treatment is that the former utilized a highly interactive approach to more actively engage T2DM patients with educational and therapeutic information, throughout the post-implementation period (10,20). This approach might be beneficial in instituting individuallytailored, need-based strategies for these patients to increase their acceptance of T2DM and ultimately improve their psychological adjustment.…”

“…Some of these medications, however, may induce adverse side effects such as weight gain and decreased glycemic control (4,8,9). In response to this, another option, the pay-for-performance (P4P) program for patients with highcost and high-risk chronic diseases, has raised attention due to its feature (10). The aim of P4P programs is to establish a complete "patient-centered" co-care model for self-care related to health education, consultation, referral system establishment, and resource linking.…”

The effects of structure, process and outcome incentives on primary care referrals to a national prevention programme

“…Despite widespread implementation of P4P schemes in healthcare over the past two decades, the evidence as to whether financial incentives are effective remains inconclusive (Flodgren et al., 2011; Kyeremanteng et al., 2019; Scott et al., 2011). Many have argued that the lack of impact demonstrated by some incentive schemes may be due to poor design (Mendelson et al., 2017).…”