Faut-il intéresser les médecins pour les motiver ? Une analyse critique du paiement à la performance médicale

Silva, Nicolas da

doi:10.3917/rdm.041.0093

Cited by 7 publications

(3 citation statements)

References 14 publications

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“…According to them, there was a risk that cost savings would take precedence over patient needs and that patient autonomy would be compromised by directing medical decisions toward meeting indicator targets. Indeed, some studies have found that payment incentive models risk eroding professional norms by encouraging extrinsic over intrinsic motivation (Da Silva 2013). However, by 2015, GPs were generally in favour of this pay-for-performance model, with 95% declaring that they had modified their practice.…”

Section: Perception Of Physiciansmentioning

confidence: 99%

Innovation in Physician Remuneration in France: What Lessons for Canada?

Denis

2019

HRO-ORS

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During the past decade, France has experienced two major reforms in remuneration models for general practitioners who work outside public health care organizations: Remuneration for Public Health Objectives (Rémunération sur Objectifs de Santé Publique-ROSP ) and Experiments with New Models of Remuneration (Expérimentations des Nouveaux Modes de Rémunération-ENMR). These two initiatives introduced payments based on performance in the areas of quality of care, organization of services and multidisciplinary practice. In the first model, individual physicians receive incentives for preventive practices, use of generics and improvements in work organization. In the second model, incentives are provided to multi-professional practice groups to foster interdisciplinary collaboration and patient involvement. While French general practitioners accustomed to fee-for-service remuneration were at first reluctant to accept a mixed remuneration model, they eventually came to embrace it. The ROSP has significantly improved targeted areas of practice, although it has had less impact on preventive practices than on use of generics and work organization. The ENMR has helped formalize inter-professional relationships in primary care and has thus contributed to team integration. These "experiments" suggest that a deliberate distinction between changes to individual physician payment and changes to how multi-professional practice groups are paid and practice may be a good starting point when introducing financial incentives to enable benefits and avoid negative consequences.

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Section: Perception Of Physiciansmentioning

confidence: 99%

Innovation in Physician Remuneration in France: What Lessons for Canada?

Denis

2019

HRO-ORS

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“…Pay-for-performance arrangements are still lacking and current performance indicators, such as hospital readmission rates and length of stay, are imperfect (Degos, 2013; Or, 2014). When they do exist, for instance, for general practitioners, they reveal ambiguous outcomes (Da Silva, 2012, 2013; GAO and Social Affairs Committee, French Senate, 2014). Another, group of stakeholders, for example, private care providers took advantage of the NPM pro-competitive regulations to expand.…”

Section: Reforms and The Medical Professionmentioning

confidence: 99%

Reforming the French health-care system: the quest for accountability

Simonet

2016

International Review of Administrative Sciences

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The resurgence of New Right politics in the late 1970s and 1980s (e.g. ‘Reaganomics’ and ‘Thatcherism’), which were pro-market and pro-private sector ( Lorenz, 2012 ), has increased the reliance on the private sector for the provision of public services. In France, the support for the private sector is no longer a partisan or ideological issue, but rather a pragmatic and increasingly routine approach to the delivery of public services. Whether this will improve the efficiency of the health-care system is still open to question. The article: investigates the use of the New Public Management toolbox ( Goldfinch and Wallis, 2009 : 151) in the French health-care system; examines its selective adoption; and assesses its impact on the accountability and transparency of the medical profession. The French government eventually opted for a re-centralization of the health-care system for monitoring purposes. The reforms antagonized the medical profession and strengthened private care providers. Point for practitioners Despite reiterated calls for devolution, the implementation of New Public Management in the French health-care system led to a greater re-centralization and rising regulations for efficiency purposes. It also allowed the French administrative elite to regain its prerogatives and regional health agencies to reform more rapidly than a multitude of local public organizations. The quest for greater accountability remains an ongoing process.

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“…Dès 2009, le Contrat d'Amélioration des Pratiques Individuelles (CAPI) proposait aux médecins libéraux volontaires d'être payés à la performance en fonction de l'atteinte d'objectifs relatifs à la qualité des soins et à la prescription de médicaments génériques [8]. La convention médicale nationale de 2011 a systématisé l'usage de ce type de rémunération à travers la Rémunération sur Objectif de Santé Publique (ROSP) S'il est légitime pour l'assurance maladie de vouloir améliorer l'usage des ressources financières et de promouvoir la qualité des soins, la pertinence des dispositifs P4P mis en place à l'étranger a fait l'objet de nombreuses critiques [9,10,11,12]. Au-delà de la faible efficacité des dispositifs de P4P, la littérature internationale a aussi mis en évidence la possibilité que le P4P médicale produise des effets inattendus et négatifs sur la qualité et l'accès aux soins.…”

Section: Introductionunclassified

Les liens entre la performance médicale et la composition de la patientèle : Une étude économétrique sur les médecins d’Ile-de-France

Silva¹,

Fleury²,

Batifoulier³

et al. 2016

Journal De Gestion Et d'Économie Médicales

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La convention médicale de 2011 a systématisé l’usage du paiement à la performance à travers la Rémunération sur Objectif de Santé Publique (ROSP). Il s’agit d’inciter financièrement le médecin à la fourniture d’une médecine de qualité et économe en s’appuyant sur des indicateurs chiffrés de résultats. Cet article propose une évaluation du ROSP à partir d’une analyse empirique pionnière en Ile-de-France. Nous testons particulièrement l’hypothèse selon laquelle la performance d’un médecin est en partie dépendante des caractéristiques de sa patientèle – la performance étant alors en partie indépendante de sa responsabilité. Dans cet esprit, nos résultats montrent que les médecins dont la patientèle est plus malade ont davantage de chance d’obtenir de meilleurs résultats. Les médecins avec une patientèle plus pauvre ont moins de chance d’obtenir de meilleurs résultats.

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Faut-il intéresser les médecins pour les motiver ? Une analyse critique du paiement à la performance médicale

Cited by 7 publications

References 14 publications

Innovation in Physician Remuneration in France: What Lessons for Canada?

Innovation in Physician Remuneration in France: What Lessons for Canada?

Reforming the French health-care system: the quest for accountability

Les liens entre la performance médicale et la composition de la patientèle : Une étude économétrique sur les médecins d’Ile-de-France

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