Specialists as consultants to GPs.<i>Private sector services as an alternative way of organising consultant services in health care</i>

Ma, None Aarno Linnala, Arpo Aromaa, Kari

doi:10.1080/028134301750235295

Cited by 8 publications

(15 citation statements)

References 7 publications

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“…Akbari 2008 searched two databases up to 2007 and included four studies investigating the effectiveness of financial incentives on the appropriateness (and rate) of referrals: one RCT (Davidson 1992), three CBAs (Coulter 1993; Kammerling 1996; Linnala 2001). The studies in the review included more than 94 primary care physicians based in more than 48 primary care practices or municipal health services, and 80 physicians in private office-based practices (the number of practices was not reported).…”

Section: Resultsmentioning

confidence: 99%

“…The studies in the review included more than 94 primary care physicians based in more than 48 primary care practices or municipal health services, and 80 physicians in private office-based practices (the number of practices was not reported). One study was based in the USA (Davidson 1992), two in the UK (Coulter 1993; Kammerling 1996), and one in Finland (Linnala 2001). One study evaluated the effects of change in the remuneration system from a low cost fee-for-service system to either a high cost fee-for-service system or a capitation-based budgetary system (with some degree of risk sharing by the provider) for the management of Medicaid-eligible paediatric care patients (Davidson 1992).…”

Section: Resultsmentioning

confidence: 99%

“…The two UK-based studies evaluated the effect of fundholding as compared to non-fundholding on referral patterns (Coulter 1993; Kammerling 1996). Linnala 2001 examined the impact of charging patients the same (lower) cost to be seen by a private specialist as they would have been charged to see a hospital-based specialist, comparing no intervention with patient incentives and a referrals list system.…”

Section: Resultsmentioning

confidence: 99%

“…One review (Akbari 2008) reported three studies that evaluated a capitation-based payment system (Coulter 1993; Kammerling 1996; Linnala 2001). One of the studies compared the effects on referral rates of providing general physicians (GPs) with a list system and the opportunity to send their patients to private specialists for consultation at a reduced cost for the patient with GPs without a list system (Linnala 2001). Two studies compared the effects of fundholding on referral rates (Coulter 1993; Kammerling 1996).…”

Section: Resultsmentioning

confidence: 99%

“…The types of stated comparisons were: i) salary reimbursement versus fee-for-service (Hickson 1987); (ii) enhanced fee-for-service versus fee-for-service (Christensen 2000; Clark 1995; Davidson 1992) or versus unspecified control (Fairbrother 1999; Fairbrother 2001); iii) fundholding (capitation) versus non-fundholding (control) in 12 studies (Baines 1997; Bradlow 1993; Burr 1992; Corney 1997; Coulter 1993; Harris 1996; Kammerling 1996; Linnala 2001; Rafferty 1997; Whynes 1997; Wilson 1995; Wilson 1999); iv) target payments and bonuses versus control (comparison intervention not specified) in nine studies (Beaulieu 2005; Fairbrother 1999; Fairbrother 2001; Grady 1997; Hillman 1998; Hillman 1999; Rosenthal 2005; Roski 2003; Shen 2003), and versus fee-for-service in two studies (Kouides 1998; Ritchie 1992); and v) mixed incentives (five studies). One study compared capitation plus financial risk sharing with low fee-for-service (Davidson 1992), a second study compared a mix of capitation and an ambulatory incentive payment with fee-for-service (Hutchison 1996), and a third study (Krasnik 1990) compared partial fee-for-service added to a capitation system with capitation and fee-for-service throughout.…”

Section: Resultsmentioning

confidence: 99%

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An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes

Flodgren

Eccles

Shepperd

et al. 2011

Cochrane Database of Systematic Reviews

298

275

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Background There is considerable interest in the effectiveness of financial incentives in the delivery of health care. Incentives may be used in an attempt to increase the use of evidence-based treatments among healthcare professionals or to stimulate health professionals to change their clinical behaviour with respect to preventive, diagnostic and treatment decisions, or both. Financial incentives are an extrinsic source of motivation and exist when an individual can expect a monetary transfer which is made conditional on acting in a particular way. Since there are numerous reviews performed within the healthcare area describing the effects of various types of financial incentives, it is important to summarise the effectiveness of these in an overview to discern which are most effective in changing health professionals’ behaviour and patient outcomes. Objectives To conduct an overview of systematic reviews that evaluates the impact of financial incentives on healthcare professional behaviour and patient outcomes. Methods We searched the Cochrane Database of Systematic Reviews (CDSR) (The Cochrane Library); Database of Abstracts of Reviews of Effectiveness (DARE); TRIP; MEDLINE; EMBASE; Science Citation Index; Social Science Citation Index; NHS EED; HEED; EconLit; and Program in Policy Decision-Making (PPd) (from their inception dates up to January 2010). We searched the reference lists of all included reviews and carried out a citation search of those papers which cited studies included in the review. We included both Cochrane and non-Cochrane reviews of randomised controlled trials (RCTs), controlled clinical trials (CCTs), interrupted time series (ITSs) and controlled before and after studies (CBAs) that evaluated the effects of financial incentives on professional practice and patient outcomes, and that reported numerical results of the included individual studies. Two review authors independently extracted data and assessed the methodological quality of each review according to the AMSTAR criteria. We included systematic reviews of studies evaluating the effectiveness of any type of financial incentive. We grouped financial incentives into five groups: payment for working for a specified time period; payment for each service, episode or visit; payment for providing care for a patient or specific population; payment for providing a pre-specified level or providing a change in activity or quality of care; and mixed or other systems. We summarised data using vote counting. Main results We identified four reviews reporting on 32 studies. Two reviews scored 7 on the AMSTAR criteria (moderate, score 5 to 7, quality) and two scored 9 (high, score 8 to 11, quality). The reported quality of the included studies was, by a variety of methods, low to moderate. Payment for working for a specified time period was generally ineffective, improving 3/11 outcomes from one study reported in one review. Payment for each service, episode or visit was generally effective, improving 7/10 outcomes from five studies reported ...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes

Flodgren

Eccles

Shepperd

et al. 2011

Cochrane Database of Systematic Reviews

298

275

View full text Add to dashboard Cite

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Interventions to improve outpatient referrals from primary care to secondary care

Akbari¹,

Mayhew²,

Al-Alawi³

et al. 2005

Cochrane Database of Systematic Reviews

159

227

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Interventions to improve outpatient referrals from primary care to secondary care

Akbari

Mayhew

Al-Alawi³

et al. 2008

Cochrane Database of Systematic Reviews

244

145

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Background The primary care specialist interface is a key organisational feature of many health care systems. Patients are referred to specialist care when investigation or therapeutic options are exhausted in primary care and more specialised care is needed. Referral has considerable implications for patients, the health care system and health care costs. There is considerable evidence that the referral processes can be improved. Objectives To estimate the effectiveness and efficiency of interventions to change outpatient referral rates or improve outpatient referral appropriateness. Search methods We conducted electronic searches of the Cochrane Effective Practice and Organisation of Care (EPOC) group specialised register (developed through extensive searches of MEDLINE, EMBASE, Healthstar and the Cochrane Library) (February 2002) and the National Research Register. Updated searches were conducted in MEDLINE and the EPOC specialised register up to October 2007. Selection criteria Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series of interventions to change or improve outpatient referrals. Participants were primary care physicians. The outcomes were objectively measured provider performance or health outcomes. Data collection and analysis A minimum of two reviewers independently extracted data and assessed study quality. Main results Seventeen studies involving 23 separate comparisons were included. Nine studies (14 comparisons) evaluated professional educational interventions. Ineffective strategies included: passive dissemination of local referral guidelines (two studies), feedback of referral rates (one study) and discussion with an independent medical adviser (one study). Generally effective strategies included dissemination of guidelines with structured referral sheets (four out of five studies) and involvement of consultants in educational activities (two out of three studies). Four studies evaluated organisational interventions (patient management by family physicians compared to general internists, attachment of a physiotherapist to general practices, a new slot system for referrals and requiring a second ‘in-house’ opinion prior to referral), all of which were effective. Four studies (five comparisons) evaluated financial interventions. One study evaluating change from a capitation based to mixed capitation and fee-for-service system and from a fee-for-service to a capitation based system (with an element of risk sharing for secondary care services) observed a reduction in referral rates. Modest reductions in referral rates of uncertain significance were observed following the introduction of the general practice fundholding scheme in the United Kingdom (UK). One study evaluating the effect of providing access to private specialists demonstrated an increase in the proportion of patients referred to specialist services but no overall effect on referral rates. Authors’ conclusions There are a limited number of rigorous eva...

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Specialists as consultants to GPs.Private sector services as an alternative way of organising consultant services in health care

Cited by 8 publications

References 7 publications

An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes

An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes

Interventions to improve outpatient referrals from primary care to secondary care

Interventions to improve outpatient referrals from primary care to secondary care

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