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Payment methods for outpatient care facilities.

Beibei Yuan1, Li He1, Qingyue Meng1

  • 1China Center for Health Development Studies (CCHDS), Peking University, 38 Xueyuan Road, Beijing, Beijing, China, 100191.

The Cochrane Database of Systematic Reviews
|March 3, 2017
PubMed
Summary
This summary is machine-generated.

Payment methods significantly influence outpatient healthcare performance. Pay for performance (P4P) may slightly improve provider test use but shows little impact on patient outcomes, necessitating careful design considerations.

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Area of Science:

  • Health Services Research
  • Health Economics
  • Public Health Policy

Background:

  • Outpatient care facilities are crucial first points of contact, significantly impacting health status and consuming substantial healthcare expenditure.
  • Payment methods are key levers for purchasers to incentivize and guide the performance of outpatient care providers.

Purpose of the Study:

  • To evaluate the impact of diverse payment methods on outpatient care facility performance.
  • To analyze how payment method impacts differ across various healthcare settings.

Main Methods:

  • Systematic review of randomized trials, non-randomized trials, and observational studies comparing outpatient facility payment methods.
  • Searched multiple databases including Cochrane, MEDLINE, Embase, PubMed, and institutional repositories.
  • Included payment methods: global budgets, capitation, fee-for-service (FFS), pay for performance (P4P), and mixed models.

Main Results:

  • Pay for performance (P4P) combined with existing methods showed a slight improvement in health professionals' test/treatment use (moderate certainty).
  • P4P demonstrated little to no difference in adherence to quality criteria, patient service utilization, or control of chronic conditions (low to moderate certainty).
  • Capitation combined with P4P slightly reduced antibiotic prescriptions compared to FFS; capitation vs. FFS effects on utilization and costs were uncertain.

Conclusions:

  • P4P may slightly enhance provider test/treatment use, especially for chronic diseases, but offers minimal gains in patient outcomes or service utilization.
  • Policymakers must carefully design P4P components (measures, targets, funding) to effectively change provider behavior.
  • Further research is needed on well-designed comparisons of payment methods in low- and middle-income countries and varied P4P/FFS designs.