Effects of Paying Physicians Based on their Relative Performance for Quality

Young, Gary J.; Meterko, Mark; Beckman, Howard; Baker, Errol; White, Bert; Sautter, Karen; Greene, Robert A.; Curtin, K.; Bokhour, Barbara G.; Berlowitz, Dan R.; Burgess, James

doi:10.1007/s11606-007-0185-5

Cited by 72 publications

(73 citation statements)

References 10 publications

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“…Similar empirical evidence is presented by Young et al (2007), Glickman et al (2007), Rosenthal et al (2009) and Campbell et al (2009). Young et al (2007 show that a U.S. P4P scheme financed via withholds leads to a modest improvement in one of four quality measures for diabetic patients.…”

Section: Literature Reviewsupporting

confidence: 83%

“…a FFS payment system), a predominant approach for the design of P4P schemes in reality (e.g., Young et al 2007). …”

Section: The Experimentsmentioning

confidence: 99%

“…Several authors do not find any significant effect of P4P incentives on physician behavior and quality of care (e.g., Hutchison et al 1996;Hillman et al 1998;Strong et al 2009). The bulk of the existing research, however, documents partial effects in that P4P incentives may lead to modest improvements in some but not all of the evaluated quality measures (e.g., Rosenthal et al 2005;Young et al 2007;Glickman et al 2007;Campbell et al 2009;Li et al 2011). …”

Section: Introductionmentioning

confidence: 99%

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Money Talks - Paying Physicians for Performance

2013

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Section: Literature Reviewsupporting

confidence: 83%

“…a FFS payment system), a predominant approach for the design of P4P schemes in reality (e.g., Young et al 2007). …”

Section: The Experimentsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Money Talks - Paying Physicians for Performance

2013

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“…These studies often suffer from poor study design: some of them only employed simple before-after mean comparison or trend comparison (Levin-Scherz et al 2006;Young et al 2007;Cutler et al 2007;Pearson et al 2008); others do not provide any comparison group as the counterfactuals (Amundson et al 2003;Mandel and Kotagal 2007;Chung et al 2010;Boland et al 2010;Lester et al 2010;Coleman et al 2007). Some of the programs were targeted at health plans or clinics instead of individual physicians, so the lack of individuallevel data makes it difficult to draw inference on physician responses to P4P incentives (FeltLisk et al 2007;Gavagan et al 2010).…”

Section: Empirical Evidence On Physician Response To P4pmentioning

confidence: 99%

Physician Response to Pay-for-Performance: Evidence from a Natural Experiment

Hurley

DeCicca

et al. 2011

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Explicit financial incentives, especially pay-for-performance (P4P) incentives, have been extensively employed in recent years by health plans and governments in an attempt to improve the quality of health care services. This study exploits a natural experiment in the province of Ontario, Canada to identify empirically the impact of pay-for-performance (P4P) incentives on the provision of targeted primary care services, and whether physicians' responses differ by age, practice size and baseline compliance level. We use an administrative data source which covers the full population of the province of Ontario and nearly all the services provided by practicing primary care physicians in Ontario. With an individual-level data set of physicians, we employ a difference-in-differences approach that controls for both "selection on observables" and "selection on unobservables" that may cause estimation bias in the identification. We also implemented a set of robustness checks to control for confounding from the other contemporary interventions of the primary care reform in Ontario. The results indicate that, while all responses are of modest size, physicians responded to some of the financial incentives but not the others. The differential responses appear related to the cost of responding and the strength of the evidence linking a service with quality. Overall, the results provide a cautionary message regarding the effectiveness of pay-for-performance schemes for increasing quality of care.

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“…Young et al (2007) investigate the effect of a program conferring limited financial risk to primary care physicians in Rochester, US, between 1999 and 2004 and find no difference between the post-and pre-intervention trends indicating that the overall increase in performance was largely independent from the incentive program. Examining 47 studies testing clinical effectiveness of incentives schemes, the survey of Van Herck et al (2010) report for diabetes the highest rate of quality improvement due to pay-for-performance implementation.…”

Section: The Role Of Financial Incentives For Health Care Improvementsmentioning

confidence: 99%

The role of GP's compensation schemes in diabetes care: Evidence from panel data

Iezzi

Bruni

Ugolini

2014

Journal of Health Economics

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The design of incentive schemes that improve quality of care is a central issue for the healthcare sector. Nowadays we observe many pay-for-performance programs, where payment is contingent on meeting indicators of provider effort, but also other alternative strategies have been introduced, for example programs rewarding physicians for participation in diseases management plans. Although it has been recognised that incentive-based remuneration schemes can have an impact on GP behaviour, there is still weak empirical evidence on the extent to which such programs influence health outcomes. We investigate the impact of financial incentives in Regional and Local Health Authority contracts for primary care in the Italian Region Emilia Romagna for the years 2003-05. We focus on avoidable hospitalisations (Ambulatory Care Sensitive Conditions) for patients affected by type 2 diabetes mellitus, for which the assumption of responsibility and the adoption of clinical guidelines are specifically rewarded. We estimate a panel count data model using a Negative Binomial distribution to test the hypothesis that, other things equal, patients under the responsibility of GPs receiving a higher share of their income through these programs are less likely to experience avoidable hospitalisations. Our findings support the hypothesis that financial transfers may contribute to improve quality of care, even when they are not based on the ex-post verification of performances.

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Effects of Paying Physicians Based on their Relative Performance for Quality

Cited by 72 publications

References 10 publications

Money Talks - Paying Physicians for Performance

Money Talks - Paying Physicians for Performance

Physician Response to Pay-for-Performance: Evidence from a Natural Experiment

The role of GP's compensation schemes in diabetes care: Evidence from panel data

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