Impact of pay for performance on inequalities in health care: systematic review

Alshamsan, Riyadh; Majeed, Azeem; Ashworth, Mark; Car, Josip; Millett, Christopher

doi:10.1258/jhsrp.2010.009113

Cited by 85 publications

(91 citation statements)

References 40 publications

(64 reference statements)

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“…54 These incentives also have a positive eff ect on coordination of care, 55 but no discernible eff ect on equity. 56 Willis-Shattuck and colleagues 57 concluded from their review that fi nancial incentives alone are insuffi cient to motivate health workers in low-income and middleincome countries.…”

Section: Improving Continuity Of Carementioning

confidence: 99%

Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition

et al. 2012

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Implementation of innovative strategies to improve coverage of evidence-based interventions, especially in the most marginalised populations, is a key focus of policy makers and planners aiming to improve child survival, health, and nutrition. We present a three-step approach to improvement of the eff ective coverage of essential interventions. First, we identify four diff erent intervention delivery channels-ie, clinical or curative, outreach, community-based preventive or promotional, and legislative or mass media. Second, we classify which interventions' deliveries can be improved or changed within their channel or by switching to another channel. Finally, we do a meta-review of both published and unpublished reviews to examine the evidence for a range of strategies designed to overcome supply and demand bottlenecks to eff ective coverage of interventions that improve child survival, health, and nutrition. Although knowledge gaps exist, several strategies show promise for improving coverage of eff ective interventionsand, in some cases, health outcomes in children-including expanded roles for lay health workers, task shifting, reduction of fi nancial barriers, increases in human-resource availability and geographical access, and use of the private sector. Policy makers and planners should be informed of this evidence as they choose strategies in which to invest their scarce resources.

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Section: Improving Continuity Of Carementioning

confidence: 99%

Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition

et al. 2012

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“…However, at least in the United Kingdom, minimal reductions in chronic disease management were observed [2]. Sustainability of gains was another issue.…”

Section: Search Strategies and Criteriamentioning

confidence: 99%

“…Sustainability of gains was another issue. Improvement may be sustained even after intervention [2,48], but at least one study suggested not only reduction in continuity in care once targets were achieved, but decline in the rate of quality of care improvement with time [15].…”

Section: Search Strategies and Criteriamentioning

confidence: 99%

The Use of Three Strategies to Improve Quality of Care at a National Level

Wright

2012

Clinical Orthopaedics &Amp; Related Research

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Background Improving the quality of care is essential and a priority for patients, surgeons, and healthcare providers. Strategies to improve quality have been proposed at the national level either through accreditation standards or through national payment schemes; however, their effectiveness in improving quality is controversial. Questions/purposes The purpose of this review was to address three questions: (1) does pay-for-performance improve the quality of care; (2) do surgical safety checklists improve the quality of surgical care; and (3) do practice guidelines improve the quality of care? These three strategies were chosen because there has been some research assessing their effectiveness in improving quality, and implementation had been attempted on a large scale such as entire countries.Methods We performed a literature review from 1950 forward using Medline to identify Level I and II studies. We evaluated the three strategies and their effects on processes and outcomes of care. When possible, we examined strategy implementation, patients, and systems, including provider characteristics, which may affect the relationship between intervention and outcomes with a focus on factors that may have influenced effect size. Results Pay-for-performance improved the process and to a lesser extent the outcome of care. Surgical checklists reduced morbidity and mortality. Explicit practice guidelines influenced the process and to a lesser extent the outcome of care. Although not definitively showed, clinician involvement during development of intervention and outcomes, with explicit strategies for communication and implementation, appears to increase the likelihood of positive results. Conclusion Although the cost-effectiveness of these three strategies is unknown, quality of care could be enhanced by implementing pay-for-performance, surgical safety checklists, and explicit practice guidelines. However, this review identified that the effectiveness of these strategies is highly context-specific.

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“…30 McGovern et al examined changes in CHD management between 2004 and 2005, and found that, compared with their more affluent counterparts, patients in the most deprived areas were less likely to have their blood pressure measured and receive betablockers or influenza immunisation, although they were more likely to receive antiplatelets and angiotensin-converting enzyme inhibitors. 31 Simpson et al used a similar study design to examine the impact of the QOF on stroke care 1 year after contract implementation.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Impact of the GP contract on inequalities associated with influenza immunisation: a retrospective population-database analysis

Norbury¹,

Fawkes²,

Guthrie³

2011

Br J Gen Pract

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Impact of pay for performance on inequalities in health care: systematic review

Abstract: Inequalities in chronic disease management have largely persisted after the introduction of the Quality and Outcome Framework. Pay for performance programmes should be designed to reduce inequalities as well as improve the overall quality of care.

Cited by 85 publications

References 40 publications

Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition

Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition

The Use of Three Strategies to Improve Quality of Care at a National Level

Impact of the GP contract on inequalities associated with influenza immunisation: a retrospective population-database analysis

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