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Pay for performance in the inpatient sector: A review of 34 P4P programs in 14 OECD countries
Ricarda Milstein1, Jonas Schreyoegg1
1Universität Hamburg, Germany; Hamburg Center for Health Economics, Germany.
Insights
Pay-for-performance (P4P) programs in hospitals across OECD countries show unclear impacts on care quality. Heterogeneous designs and potential side effects mean P4P may not meet expectations.
Area of Science:
- Health Services Research
- Health Economics
- Public Health Policy
Background:
- Hospitals in Organisation for Economic Co-operation and Development (OECD) countries utilize pay-for-performance (P4P) initiatives.
- These programs aim to enhance the quality of inpatient care delivery.
Purpose of the Study:
- To provide a comprehensive overview of P4P programs in the inpatient hospital sector across 14 OECD nations.
- To analyze the design, financial incentives, and reported effects of these P4P systems.
- To assess whether current evaluations permit preliminary conclusions on P4P effectiveness.
Main Methods:
- A structured literature search was conducted across five databases.
- Information was gathered on 34 P4P programs in 14 OECD countries.
- Data included program aims, selected quality indicators, and financial reward structures.
Main Results:
- Significant heterogeneity exists among P4P programs regarding objectives, indicators, and financial reward mechanisms.
- The overall impact of P4P on inpatient care quality remains unclear.
- Observed moderate positive effects may stem from confounding factors like public reporting and improved data recording awareness.
Conclusions:
- Existing P4P programs have not consistently met initial expectations for improving hospital quality.
- Policymakers must carefully weigh the potential benefits against risks in their specific national or regional contexts.
- Further research is needed to clarify the true impact of P4P and its underlying mechanisms.
Abstract:
Across the member countries of the Organisation for Economic Co-operation and Development (OECD), pay-for-performance (P4P) programs have been implemented in the inpatient sector to improve the quality of care provided by hospitals. This paper provides an overview of 34 existing P4P programs in the inpatient sector in 14 OECD countries based on a structured literature search in five databases to identify relevant sources in Danish, English, French, German, Hebrew, Italian, Japanese, Korean, Norwegian, Spanish, Swedish and Turkish. It assembles information on the design and effects of these P4P systems and discusses whether evaluations of such programs allow preliminary conclusions to be drawn about the effects of P4P. The programs are very heterogeneous in their aim, the selection of indicators and the design of financial rewards. The impact of P4P is unclear and it may be that the moderately positive effects seen for some programs can be attributed to side effects, such as public reporting and increased awareness of data recording. Policy makers must decide whether the potential benefits of introducing a P4P program outweigh the potential risks within their particular national or regional context, and should be aware that P4P programs have yet not lived up to expectations.
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