Physician Response to Pay-for-Performance: Evidence from a Natural Experiment

The satisfaction of physicians is a worldwide issue linked with the quality of health services; their satisfaction needs to be studied from a multi-dimensional perspective, considering lower- and higher-order needs. The objectives of this study were to: i) measure the career satisfaction of physicians; ii) identify differences in the dimensions of career satisfaction; and iii) test factors that affect higher- and lower-order needs of satisfaction among physicians working in Andalusian hospitals (Spain). Forty-one percent of 299 eligible physicians participated in a study conducted in six selected hospitals. Physicians reported higher professional, inherent, and performance satisfaction than personal satisfaction. Foreign physicians reported higher levels of personal and performance satisfaction than local physicians, and those who received non-monetary incentives had higher professional and performance satisfaction. In conclusion, physicians in the selected Andalusian hospitals reported low levels of personal satisfaction. Non-monetary incentives were more relevant to influence their career satisfaction. Further investigations are recommended to study differences in the career satisfaction between foreign and local physicians.

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“… 21 In fact, monetary incentives have shown modest results, like the pay-per-performance program in Ontario, Canada. 22 …”

Section: Discussionmentioning

confidence: 99%

Factors identified with higher levels of career satisfaction of physicians in Andalusia, Spain

et al. 2014

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Section: Resultsmentioning

confidence: 99%

“…All four studies examining various outcomes related to screening and prevention activities in new payment models used pre/post study designs [ 11 , 12 , 15 , 18 ]. Two of these studies included a control group using a difference-in-differences analysis [ 12 , 18 ]. Kralj et al [ 18 ] examined the effect of blended capitation payment on the delivery of the cancer screening and preventive care targets (senior flu shots, Pap smears, mammograms, immunizations and colorectal cancer screening).…”

Section: Resultsmentioning

confidence: 99%

The impact of primary care reform on health system performance in Canada: a systematic review

Carter

Riverin

Lévesque

et al. 2016

BMC Health Serv Res

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BackgroundWe aimed to synthesize the evidence of a causal effect and draw inferences about whether Canadian primary care reforms improved health system performance based on measures of health service utilization, processes of care, and physician productivity.MethodsWe searched the Embase, PubMed and Web of Science databases for records from 2000 to September 2015. We based our risk of bias assessment on the Grading of Recommendations Assessment, Development and Evaluation guidelines. Full-text studies were synthesized and organized according to the three outcome categories: health service utilization, processes of care, and physician costs and productivity.ResultsWe found moderate quality evidence that team-based models of care led to reductions in emergency department use, but the evidence was mixed for hospital admissions. We also found low quality evidence that team-based models, blended capitation models and pay-for-performance incentives led to small and sometimes non-significant improvements in processes of care. Studies examining new payment models on physician costs and productivity were of high methodological quality and provided a coherent body of evidence assessing enhanced fee-for-service and blended capitation payment models.ConclusionA small number of studies suggested that team-based models contributed to reductions in emergency department use in Quebec and Alberta. Regarding processes of diabetes care, studies found higher rates of testing for blood glucose levels, retinopathy and cholesterol in Alberta’s team-based primary care model and in practices eligible for pay-for-performance incentives in Ontario. However pay-for-performance in Ontario was found to have null to moderate effects on other prevention and screening activities. Although blended capitation payment in Ontario contributed to decreases in the number of services delivered and patients seen per day, the number of enrolled patients and number of days worked in a year was similar to that of enhanced fee-for-service practices.

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“…Likewise, allocation of permits by lottery to allow Fijians to emigrate to New Zealand allowed researchers to study the effects of migration on health and well-being many years later 15 16. Other studies may take the form of natural experiments: observational studies where a researcher ‘can make a credible claim that the assignment of the nonexperimental subjects to treatment and control conditions is ‘as if’ random.’17 For instance, a study in Canada of the impact of a pay-for-performance scheme, where some but not all of the physicians were exposed to the incentives, allowed a quasiexperimental evaluation where no aspect of the assignment of the physicians to the programme was controlled by the researchers 18…”

Section: Study Designs For Opportunistic Evaluationsmentioning

confidence: 99%

Revising ethical guidance for the evaluation of programmes and interventions not initiated by researchers

et al. 2019

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Public health and service delivery programmes, interventions and policies (collectively, ‘programmes’) are typically developed and implemented for the primary purpose of effecting change rather than generating knowledge. Nonetheless, evaluations of these programmes may produce valuable learning that helps determine effectiveness and costs as well as informing design and implementation of future programmes. Such studies might be termed ‘opportunistic evaluations’, since they are responsive to emergent opportunities rather than being studies of interventions that are initiated or designed by researchers. However, current ethical guidance and registration procedures make little allowance for scenarios where researchers have played no role in the development or implementation of a programme, but nevertheless plan to conduct a prospective evaluation. We explore the limitations of the guidance and procedures with respect to opportunistic evaluations, providing a number of examples. We propose that one key missing distinction in current guidance is moral responsibility: researchers can only be held accountable for those aspects of a study over which they have control. We argue that requiring researchers to justify an intervention, programme or policy that would occur regardless of their involvement prevents or hinders research in the public interest without providing any further protections to research participants. We recommend that trial consent and ethics procedures allow for a clear separation of responsibilities for the intervention and the evaluation.

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Physician Response to Pay-for-Performance: Evidence from a Natural Experiment

Cited by 25 publications

References 25 publications

Factors identified with higher levels of career satisfaction of physicians in Andalusia, Spain

Factors identified with higher levels of career satisfaction of physicians in Andalusia, Spain

The impact of primary care reform on health system performance in Canada: a systematic review

Revising ethical guidance for the evaluation of programmes and interventions not initiated by researchers

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