Performance-Based Financial Incentives for Diabetes Care: An Effective Strategy?

Abstract

The use of financial incentives provided to primary care physicians who achieve target management or clinical outcomes has been advocated to support the fulfillment of care recommendations for patients with diabetes. This article explores the characteristics of incentive models implemented in the context of universal healthcare systems in the United Kingdom, Australia, Taiwan and Canada; the extent to which these interventions have been successful in improving diabetes outcomes; and the key challenges and concerns around implementing incentive models. Research in the effect of incentives in the United Kingdom demonstrates some improvements in process outcomes and achievement of cholesterol, blood pressure and glycated hemoglobin (A1C) targets. Evidence of the efficacy of programs implemented outside of the United Kingdom is very limited but suggests that physicians participating in these enhanced billing incentive programs were already completing the guideline-recommended care prior to the introduction of the incentive. A shift to pay-for-performance programs may have important implications for professionalism and patient-centred care. In the absence of definitive evidence that financial incentives drive the quality of diabetes management at the level of primary care, policy makers should proceed with caution. It is important to look beyond simply modifying physicians' behaviours and address the factors and systemic barriers that make it challenging for patients and physicians to manage diabetes in partnership.

Impact of pay for performance on behavior of primary care physicians and patient outcomes

“…Apart from this, there are researches directly revealed that P4P actually had a very limited function, and process indicators had higher rates of improvement than that of endpoint indicators. As Coleman et al presented, the rate of HbA1c screening (a process outcome) increased while the blood glucose level (an endpoint outcome) remained unchanged, which was also confirmed by Latham and Marshall . Considering all above, other factors, besides P4P, need to be considered so that the clinical performance can objectively be evaluated and truly improved on the basis of diverse baselines, which was similar to the previous studies .…”

Health care professionals talking: Are services for young adults with type 1 diabetes fit for purpose?

“…Perhaps engagement with diabetes health care services could be promoted if equipment subsidies were conditional on this. Financial incentives for health care professionals could also be considered, although their influence on outcomes have not been demonstrated …”

A cluster randomized trial on the effect of a multifaceted intervention improved the technical quality of diabetes care by primary care physicians: The Japan Diabetes Outcome Intervention Trial‐2 (J‐DOIT2)

“…This might be related to the use of quality‐of‐care measures such as comparing provider performance or the use of performance incentives . In other areas in the world founded on the presumption that guideline‐based care will generate savings by reducing demands on costly hospital‐based services over the long‐term incentive programmes aimed at improving diabetes outcomes are increasing in popularity . The concept of measuring the effectiveness among diabetes care providers is not new.…”