Will Pay-For-Performance And Quality Reporting Affect Health Care Disparities?

Abstract

Pay-for-performance (P4P) and public quality-reporting programs can increase the quality of health care for the services being measured. However, unless carefully designed, these programs may have the unintended consequence of increasing racial and ethnic disparities. This paper describes ways in which P4P and public reporting programs may increase disparities and suggests ways in which programs might be designed that will make them likely to reduce, or at least not increase, disparities.

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

“…34 Rather, immunisation uptake increased for all groups of patients and gaps narrowed, although not significantly in terms of socioeconomic inequalities. In the same vein, the findings do not support concerns expressed in the US that pay-forperformance systems like the QOF will widen inequalities, 35 although this conclusion could depend, in part, on the QOF payment-system design, where the ability to exception-report means practices are not financially penalised for serving 'harder-to-reach' populations. 36 However, there was no evidence that socioeconomic differences in uptake were reduced after implementation of the QOF.…”

Quality and financial outcomes from gainsharing for inpatient admissions: A three‐year experience

“…17 Other authors have questioned whether widespread implementation of such a program could potentially increase healthcare disparities in the community. 18 It has been suggested by Greene and Nash that for a program to be successful, physicians who feel they provide good care yet but are not rewarded should be given an independent review. 16 Such a process is important to prevent resentment among physicians who are unable to meet benchmarks for payment, despite hard work.…”

Patient Satisfaction Reporting and Its Implications for Patient Care

“…If institutions that have a greater safety net function have more challenging patient populations and fewer resources to devote to improving low scores, financial incentives could exacerbate existing inequities in care. Additionally, quality reporting can widen racial and clinical disparities in care [17]: faced with penalties for low patient satisfaction scores, physicians could avoid caring for patients who may be more challenging to treat and perceived to be difficult to please, that is, underserved minorities, those with lower socioeconomic status, and those with mental health concerns. There are already disparities in care across our health care system, and incentives for patient satisfaction have the potential to make the situation worse.…”