Article type
Year
Abstract
Background: Pilot countries such as the UK have suggested that pay-for-performance (P4P) is an effective payment method, which links physicians’ income to the quality of their services. With its wide application in primary health care, more countries are exploring its role among general practitioners. Interestingly, research on P4P has yet to reach an agreement, so a systematic review was performed for a more affirmative result.
Objectives: To provide a comprehensive and objective evaluation of P4P for decision-makers.
Methods: Studies were identified by searching PubMed, EMBASE and the Cochrane Library. Electronic searching was conducted in the fourth week of January 2013. As the included studies had significant clinical heterogeneity, a descriptive analysis was conducted, and a Quality Index was used to assess the quality of the evidence.
Results: Among the 44 included articles (Table 1), 36 were about the effect of P4P on quality of chronic diseases (Table 2); 20 were about equity(Table 3), five about satisfaction of patients, four about cost-effectiveness, 24 about a factor of implementation of P4P( the baseline of P4P and the practice size). P4P had an overall positive effect, which varied in accordance with the baseline quality of medical care and the practice size. The implementation of P4P could bring about new problems regarding the inequity of medical care, patients’ dissatisfaction and the rise of medical cost.
Conclusions: Decision makers should consider the baseline conditions of medical quality and the practice size before new medical policies are enacted. Furthermore, most studies investigated here were retrospective and observational with high levels of heterogeneity, though the descriptive analysis is still of significance.
Objectives: To provide a comprehensive and objective evaluation of P4P for decision-makers.
Methods: Studies were identified by searching PubMed, EMBASE and the Cochrane Library. Electronic searching was conducted in the fourth week of January 2013. As the included studies had significant clinical heterogeneity, a descriptive analysis was conducted, and a Quality Index was used to assess the quality of the evidence.
Results: Among the 44 included articles (Table 1), 36 were about the effect of P4P on quality of chronic diseases (Table 2); 20 were about equity(Table 3), five about satisfaction of patients, four about cost-effectiveness, 24 about a factor of implementation of P4P( the baseline of P4P and the practice size). P4P had an overall positive effect, which varied in accordance with the baseline quality of medical care and the practice size. The implementation of P4P could bring about new problems regarding the inequity of medical care, patients’ dissatisfaction and the rise of medical cost.
Conclusions: Decision makers should consider the baseline conditions of medical quality and the practice size before new medical policies are enacted. Furthermore, most studies investigated here were retrospective and observational with high levels of heterogeneity, though the descriptive analysis is still of significance.