Health spending continues to grow faster than the economy in most OECD countries. In 2010, the OECD published a study of strategies to increase value for money in health care, in which pay for performance (P4P) was identified as an innovative tool to improve health system efficiency in several OECD countries. However, evidence that P4P increases value for money, boosts quality of processes in health care, or improves health outcomes is limited. This book explores the many questions surrounding P4P such as whether the potential power of P4P has been over-sold, or whether the disappointing results to date are more likely rooted in problems of design and implementation or inadequate monitoring and evaluation. The book also examines the supporting systems and process, in addition to incentives, that are necessary for P4P to improve provider performance and to drive and sustain improvement. The book utilises a substantial set of case studies from 12 OECD countries to shed light on P4P programs in practice. Featuring both high and middle income countries, cases from primary and acute care settings, and a range of both national and pilot programmes, each case study features:• Analysis of the design and implementation decisions, including the role of stakeholders • Critical assessment of objectives versus results • Examination of the of 'net' impacts, including positive spillover effects and unintended consequences The detailed analysis of these 12 case studies together with the rest of this critical text highlight the realities of P4P programs and their potential impact on the performance of health systems in a diversity of settings. As a result, this book provides critical insights into the experience to date with

Paying For Performance In Healthcare: Implications For Health System Performance And Accountability

Aims

To evaluate the effect of multifaceted interventions using the Achievable Benchmark of Care (ABC) method for improving the technical quality of diabetes care in primary care settings.



Methods

We conducted a 1-year cluster randomized controlled trial in 22 regions divided into an intervention group (IG) or control group (CG). Physicians in the IG received a monthly report of their care quality, with the top 10% quality of diabetes care scores for all physicians being the achievable benchmark. The change in quality-of-care scores between the IG and CG during follow-up was analysed using a generalized linear model considering clustering.



Results

A total of 2199 patients were included. Their mean (sd) age was 56.5 ± 5.9 years and the mean (sd) HbA1c level was 56.4 ± 13.3 mmol/mol (7.4 ± 1.2%). The quality-of-care score in the CG changed from 50.2%-point at baseline to 51%-point at 12 months, whereas the IG score changed from 49.9%-point to 69.6%-point, with statistically significant differences between the two groups during follow-up [the effect of intervention was 19.0%-point (95% confidence interval 16.7%- to 21.3%-point; P < 0.001)].



Conclusions

Multifaceted intervention, measuring quality-of-care indicators and providing feedback regarding the quality of diabetes care to physicians with ABC, was effective for improving the technical quality of care in patients with Type 2 diabetes in primary care settings. (Trial Registration: umin.ac.jp/ctr as UMIN000002186)

https://onlinelibrary.wiley.com/doi/pdf/10.1111/dme.12949

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).

Primary care reform : a case study of Ontario.

Atherosclerotic cardiovascular disease and heart failure: Determinants of risk and outcomes in patients with diabetes.

This paper analyses recent health reform agenda in Canada. From 1988 until 1997, the first phase of reforms focused on service integration through regionalisation and a rebalancing of services from illness care to prevention and wellness. The second phase, which has been layered onto the ongoing first phase, is concerned with fiscal sustainability from a provincial perspective, and the fundamental nature of the system from a national perspective. Despite numerous commissions and studies, some questions remain concerning the future direction of the public system. The Canadian reform experience is compared with recent Australian health reform initiatives in terms of service integration through regionalisation, primary care reform, Aboriginal health, the public-private debate, intergovernmental relations and the role of the federal government.

/pdf/canadian-health-system-reforms-lessons-for-australia-5czf970n57.pdf

Canadian Health System Reforms: Lessons for Australia?

In recent years, the Canadian health care system’s universality, comprehensiveness, and accessibility have been shaken by the effects of increasing medical technology, contraction of the hospital sector, an aging population, and widespread physician shortages. All have contributed to a situation where access to care is becoming difficult, health services fragmented, and health care workers increasingly demoralized. In response, there has been no shortage of proposals for reform, particularly in the area of primary care. Government, medical organizations, and health advocacy groups have tackled the issue. Despite two decades of endeavour, no province has implemented meaningful reform. In the same period, Australia has revolutionized the organization and delivery of general practice care. At this time of uncertainty in Canadian family medicine, perhaps something can be learned from the Australian experience.

https://www.cfp.ca/content/cfp/48/3/440.full.pdf

Geoff Mitchell

Papers

Primary care reform: View from Australia