Impact of Pay-for-Performance on Efficiency and Effectiveness in Hospitals: A Systematic Review

Abstract

Ab s t r a c tPurpose: Pay-for-performance (P4P) refers to the transfer of money on taking a measurable action or achieving a predetermined performance target. In this systematic review, we will present the results of P4P impacts based on published articles. Methods:A systematic review of literature was done using following databases and search engines: PubMed, Web of knowledge, Sciencedirect, The Cochrane library, MagIran and SID. Keywords used were, Pay-for-performance, P4P, output based payment, result based payment, financial incentives, value based purchasing, effectiveness, efficiency, cost, quality, patient satisfaction, provider satisfaction, mortality, length of stay, clinical outcomes, charges, access, hospitalization, equity, patient outcome, outcome of care. No limitations were considered for time of publishing studies, and searching articles was continued until February 2013. Only impact of P4P on physicians and nurses in hospitals were considered. The literature search yielded 7172 records, of which 34 met our inclusion criteria. Results:Thirty-four studies were included in this systematic review taking part in different countries and settings with different type of studies. P4P effects can be judged to be encouraging or disappointing, depending on the design choices and characteristics of the context in which it was introduced. Conclusion:The impact of P4P targeting physicians and nurses seems to be positive on most of the effectiveness and efficiency indicators. However, implementation of P4P should be accompanied by robust evaluation plans.

An Analysis of Pay-for-Performance Schemes and Their Potential Impacts on Health Systems and Outcomes for Patients

“…In the same year, Glickman et al published a study on quality improvement, using the reward-based P4P for cardiac patients, while studying 54 American hospitals participating in a federally funded P4P pilot project, compared to 446 control hospitals, and found that the program did not appear to impact quality of care [16]. A few years later, a multicountry meta-analysis of P4P was conducted, yielding similarly contradictory results and ultimately concluding that P4P effects can vary widely, depending on the specific analyzed instance and on a number of contextual factors, such as the relative magnitude of the incentives, how the target goals were measured, the length of the intervention, and the type of medical treatment sought [17]. Due to the wide range of contexts found in the thirty-four studies selected for analysis, the authors do not offer specific recommendations as to which combination of factors may be most effective, as data are still lacking to provide this type of foundational hypothesis [17].…”

“…A few years later, a multicountry meta-analysis of P4P was conducted, yielding similarly contradictory results and ultimately concluding that P4P effects can vary widely, depending on the specific analyzed instance and on a number of contextual factors, such as the relative magnitude of the incentives, how the target goals were measured, the length of the intervention, and the type of medical treatment sought [17]. Due to the wide range of contexts found in the thirty-four studies selected for analysis, the authors do not offer specific recommendations as to which combination of factors may be most effective, as data are still lacking to provide this type of foundational hypothesis [17]. As mentioned previously, the magnitude of the offered financial incentive may be one of those factors influencing outcomes of P4P practices.…”

“…It is fair to say that more money is likely to create more change? One study suggested that a 5% increase in capitated physician income might be meaningful enough to influence behaviour [18]; yet environment and context also play a role, independent of raw compensation [17].…”