Target payments in primary care: effects on professional practice and health care outcomes.
Antonio Giuffrida,Toby Gosden,Frode Forland,Ivar Sønbø Kristiansen,Michelle Sergison,Brenda Leese,Lone Pedersen,Matt Sutton +7 more
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TLDR
The use of target payments in the remuneration of PCPs was associated with improvements in immunisation rates, but the increase was statistically significant in only one of the two studies.Abstract:
BACKGROUND: The method by which physicians are paid may affect their professional practice. Although payment systems may be used to achieve policy objectives (e.g. improving quality of care, cost containment and recruitment to under-served areas), little is known about the effects of different payment systems in achieving these objectives. Target payments are a payment system which remunerate professionals only if they provide a minimum level of care. OBJECTIVES: To evaluate the impact of target payments on the professional practice of primary care physicians (PCPs) and health care outcomes. SEARCH STRATEGY: We searched the Cochrane Effective Practice and Organisation of Care Group specialised register; the Cochrane Controlled Trials Register; MEDLINE (1966 to October 1997); BIDS EMBASE (1980 to October 1997); BIDS ISI (1981 to October 1997); EconLit (1969 to October 1997); HealthStar (1975 to October 1997) Helmis (1984 to October 1997); health economics discussion paper series of the Universities of York, Aberdeen, Sheffield, Bristol, Brunel, and McMaster; Swedish Institute of Health Economics; RAND corporation; and reference lists of articles. SELECTION CRITERIA: Randomised trials, controlled before and after studies and interrupted time series analyses of interventions comparing the impact of target payments to primary care professionals with alternative methods of payment, on patient outcomes, health services utilisation, health care costs, equity of care, and PCP satisfaction with working environment. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Two studies were included involving 149 practices. The use of target payments in the remuneration of PCPs was associated with improvements in immunisation rates, but the increase was statistically significant in only one of the two studies. REVIEWER'S CONCLUSIONS: The evidence from the studies identified in this review is not of sufficient quality or power to obtain a clear answer to the question as to whether target payment remuneration provides a method of improving primary health care. Additional efforts should be directed in evaluating changes in physicians' remuneration systems. Although it would not be difficult to design a randomised controlled trial to evaluate the impact of such payment systems, it would be difficult politically to conduct such trials.read more
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Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians.
Toby Gosden,Frode Forland,Ivar Sønbø Kristiansen,Matt Sutton,Brenda Leese,Antonio Giuffrida,Michelle Sergison,Lone Pedersen +7 more
TL;DR: There is some evidence to suggest that the method of payment of primary care physicians affects their behaviour, but the findings' generalisability is unknown, especially in terms of the relative impact of salary versus capitation payments.
References
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Journal ArticleDOI
Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians.
Toby Gosden,Frode Forland,Ivar Sønbø Kristiansen,Matt Sutton,Brenda Leese,Antonio Giuffrida,Michelle Sergison,Lone Pedersen +7 more
TL;DR: There is some evidence to suggest that the method of payment of primary care physicians affects their behaviour, but the findings' generalisability is unknown, especially in terms of the relative impact of salary versus capitation payments.
Journal ArticleDOI
Performance-based physician reimbursement and influenza immunization rates in the elderly
Ruth Kouides,Nancy M. Bennett,Lewis B,Cappuccio Jd,Cappuccio Jd,William H. Barker,LaForce Fm +6 more
TL;DR: Despite high background immunization rates, this modest financial incentive was responsible for approximately 7% increase in immunization rate among the ambulatory elderly.
Journal ArticleDOI
Improving physicians' preventive health care behavior through peer review and financial incentives.
TL;DR: Improvement of preventive health care behaviors by physicians in an independent practice association-health maintenance organization measured changes through chart audit, accompanied by peer review, feedback, and financial incentives.
Journal ArticleDOI
A New Definition of Primary Care
Journal ArticleDOI
The effect of per-item fees on the behaviour of general practitioners
David Hughes,Brian Yule +1 more
TL;DR: Changes in per-item fees over the period 1966-89 appear to have had little effect on the numbers of treatments; rather service provision was related to patient demand and the availability of GPs.