Impact of financial incentives on clinical autonomy and internal motivation in primary care: ethnographic study

McDonald, Ruth; Harrison, Stephen; Checkland, Kath; Campbell, Stephen; Roland, Martin

doi:10.1136/bmj.39238.890810.be

Cited by 151 publications

(159 citation statements)

References 16 publications

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“…143,144 Maintaining fee-for-service reimbursement supports provision of essential face-to-face services. However fee-for-service reimbursement should be broadened to embrace e-mail or Web-based virtual office visits, perhaps pegging them to some proportion of a routine office visit.…”

Section: Reimbursement Modelsmentioning

confidence: 99%

“…Observation studies have confirmed that practices add staff, install electronic records, and network with community agencies to be eligible for incentives. 105,144 To be effective, criteria must be measurable, based on evidence, and amenable to medical management. Both the measures and incentives must be chosen and incentivized with care to assure providers do not simply deselect complex patients, for it is the complex patients who have the most to gain in a medical home environment.…”

Section: Reimbursement Modelsmentioning

confidence: 99%

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The Medical Home: Growing Evidence to Support a New Approach to Primary Care

Rosenthal¹

2008

The Journal of the American Board of Family Medicine

446

341

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Introduction:A medical home is a patient-centered, multifaceted source of personal primary health care. It is based on a relationship between the patient and physician, formed to improve the patient's health across a continuum of referrals and services. Primary care organizations, including the American Board of Family Medicine, have promoted the concept as an answer to government agencies seeking political solutions that make quality health care affordable and accessible to all Americans.Methods: Standard literature databases, including PubMed, and Internet sites of numerous professional associations, government agencies, business groups, and private health organizations identified over 200 references, reports, and books evaluating the medical home and patient-centered primary care.Findings: Evaluations of several patient-centered medical home models corroborate earlier findings of improved outcomes and satisfaction. The peer-reviewed literature documents improved quality, reduced errors, and increased satisfaction when patients identify with a primary care medical home. Patient autonomy and choice also contributes to satisfaction. Although industry has funded case management models demonstrating value superior to traditional fee-for-service reimbursement adoption of the medical home as a basis for medical care in the United States, delivery will require effort on the part of providers and incentives to support activities outside of the traditional face-to-face office visit.Conclusions: Evidence from multiple settings and several countries supports the ability of medical homes to advance societal health. A combination of fee-for-service, case management fees, and quality outcome incentives effectively drive higher standards in patient experience and outcomes. Community/ provider boards may be required to safeguard the public interest.

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Section: Reimbursement Modelsmentioning

confidence: 99%

Section: Reimbursement Modelsmentioning

confidence: 99%

The Medical Home: Growing Evidence to Support a New Approach to Primary Care

Rosenthal¹

2008

The Journal of the American Board of Family Medicine

446

341

View full text Add to dashboard Cite

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“…However, the fragmentation of roles in primary care reduces the possibility of dealing with human suffering in a multidimensional way. The QOF has the potential to reduce the doctors' role to that of achieving targets-completing computerised templates in the consultation and delegating more mechanical activities to nurses, seen by doctors as the best followers of guidelines 5 .…”

Section: Personal Continuity Of Carementioning

confidence: 99%

“…The QOF is a point-based system with three main types of indicators for obtaining the points 7 (Table 2). Moreover, QOF represents the biggest change in general practitioners contracts since 1966 8 and is considered the boldest such initiative in the world 5 . In 2004, each QOF point earned a practice about £75 sterling, evolving to £124.60 (2005/6) and reaching £130.00 (2011/12) 6 , representing a 20% increase in general practitioners' salaries 9 and costing the National Health Service (NHS) in excess of £1 billion 5 .…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, QOF represents the biggest change in general practitioners contracts since 1966 8 and is considered the boldest such initiative in the world 5 . In 2004, each QOF point earned a practice about £75 sterling, evolving to £124.60 (2005/6) and reaching £130.00 (2011/12) 6 , representing a 20% increase in general practitioners' salaries 9 and costing the National Health Service (NHS) in excess of £1 billion 5 . In the first year, general practitioners achieved 959 (91%) of the available points, above the expected 750 set by policy makers, which meant 'the trust had to find an extra £200m' to cover the difference 10 .…”

Section: Introductionmentioning

confidence: 99%

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The payment for performance model and its influence on British general practitioners' principles and practice

2014

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This article explores some effects of the British payment for performance model on general practitioners’ principles and practice, which may contribute to issues related to financial incentive modalities and quality of primary healthcare services in low and middle-income countries. Aiming to investigate what general practitioners have to say about the effect of the British payment for performance on their professional ethos we carried out semi-structured interviews with 13 general practitioner educators and leaders working in academic medicine across the UK. The results show a shift towards a more biomedical practice model and fragmented care with nurse practitioners and other health care staff focused more on specific disease conditions. There has also been an increased medicalisation of the patient experience both through labelling and the tendency to prescribe medications rather than non-pharmacological interventions. Thus, the British payment for performance has gradually strengthened a scientific-bureaucratic model of medical practice which has had profound effects on the way family medicine is practiced in the UK.

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Exploring the effectiveness of a P4P scheme from the perspective of Italian general practitioners: A replication study

Giancotti

Mauro

Rania

2022

Health Planning & Management

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A major problem of the primary healthcare system is the deficiency in performance quality. From the second half of the 20th century, many countries introduced pay for performance reimbursement schemes to encourage practitioner behaviour to align with specific objectives of decision-makers and to incentivise the provision of targeted services. The study of Krauth et al. (2016) provides key evidence from a European country, determining whether German general practitioners would participate in a pay for performance programme and under what conditions. Our research replicates this survey, adjusting it to the Italian context. We assessed the attitudes of Italian general practitioners towards the current remuneration scheme and analysed how such views varied among respondents. Results showed that the current remuneration scheme for Italian general practitioners does not seem to be proportional to the efforts given for the provision of care and does not provide appropriate incentives to supply high-quality healthcare. Most of respondents supported the introduction of a pay for performance remuneration system, although perceived potential obstacles. We conclude that for a successful implementation of a quality-based compensation scheme, GPs should be involved. Such participation would help better identify perceived obstacles and overcome them.

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Impact of financial incentives on clinical autonomy and internal motivation in primary care: ethnographic study

Abstract: Objective To explore the impact of financial incentives for quality of care on practice organisation, clinical autonomy, and internal motivation of doctors and nurses working in primary care.

Cited by 151 publications

References 16 publications

The Medical Home: Growing Evidence to Support a New Approach to Primary Care

The Medical Home: Growing Evidence to Support a New Approach to Primary Care

The payment for performance model and its influence on British general practitioners' principles and practice

Exploring the effectiveness of a P4P scheme from the perspective of Italian general practitioners: A replication study

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