Financial Incentives And Measurement Improved Physicians’ Quality Of Care In The Philippines

Abstract

The merits of using financial incentives to improve clinical quality have much appeal, yet few studies have rigorously assessed the potential benefits. The uncertainty surrounding assessments of quality can lead to poor policy decisions, possibly resulting in increased cost with little or no quality improvement, or missed opportunities to improve care. We conducted an experiment involving physicians in thirty Philippine hospitals that overcomes many of the limitations of previous studies. We measured clinical performance and then examined whether modest bonuses equal to about 5 percent of a physician's salary, as well as system-level incentives that increased compensation to hospitals and across groups of physicians, led to improvements in the quality of care. We found that both the bonus and system-level incentives improved scores in a quality measurement system used in our study by ten percentage points. Our findings suggest that when careful measurement is combined with the types of incentives we studied, there may be a larger impact on quality than previously recognized.

The role of national health insurance for achieving UHC in the Philippines: a mixed methods analysis

“…Providers are both public and private, and the payment method for the package is reimbursements to drug outlets for the medicines, and capitation for health care providers for the Tsekap services including diagnostic tests. The Tsekap benefit package is estimated to cost 615 PHP (12 USD) per person or 1562 PHP (30 USD) per family at family size of 2.54 [29]. …”

“…Peabody and colleagues [29] show that even modest financial incentives provided by a hospital-wide expansion of PhilHealth benefits (greater revenue in the form of insurance benefits covering 100% of costs for ordinary cases of common conditions such as pneumonia and diarrhea) led to significant and lasting positive effects on the quality of care provided. Although positive from a clinical quality perspective, this expansion also indicates an example of inefficient and non-strategic purchasing, as such common conditions should rather not been provided (and paid for) at hospitals, but at primary health centers.…”

Multitasking and Heterogeneous Treatment Effects in Pay-for-Performance in Health Care: Evidence from Rwanda

“…Evaluations of P4P programs in such diverse countries as the Philippines, Indonesia, the Democratic Republic of the Congo and Burundi have found improvements in provider knowledge (Peabody et al 2011), increases in healthcare workers' labor (Olken, Onishi, and Wong 2014), increases in utilization of care and improvements in in some measures of health care quality (Soeters et al 2011, Bonfrer, Van de Poel, andVan Doorslaer 2014). Still, there exist gaps in our understanding of P4P's impacts in these settings.…”

Overuse of Cardiovascular Services

“…70 Administrative and clinical data and, in some cases, patient input are needed to make these specific measures fully operational, highlighting the complexity of overuse measurement and its applicability for audit and feedback, public reporting, and payment determination. 71 Furthermore, newer, more effective methods of physician behavior change such as direct physician engagement, 72 clinical performance vignettes, 73 and clinical decision support 74 will need to be used. To date, few published reports have used AUC specifically as quality improvement tools to reduce overuse.…”