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Pay for performance for hospitals.

Tim Mathes1, Dawid Pieper, Johannes Morche

  • 1Institute for Research in Operative Medicine (IFOM) - Department for Evidence-based Health Services Research, University Witten/Herdecke, Ostmerheimer Str. 200 (House 38), Cologne, Germany, 51109.

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This summary is machine-generated.

Pay-for-Performance (P4P) programs show uncertain impacts on hospital care quality and outcomes. Non-payment models and quality attainment incentives appear more effective than bonuses for sustainable improvements.

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Area of Science:

  • Health Services Research
  • Health Economics
  • Quality Improvement

Background:

  • Pay-for-Performance (P4P) models incentivize healthcare providers using financial rewards tied to quality indicators.
  • These models aim to enhance the quality and efficacy of healthcare delivery.

Purpose of the Study:

  • To comprehensively assess the impact of P4P on in-hospital care quality, resource utilization, and equity.
  • To analyze intervention components, contextual factors, and their interrelations within P4P programs.

Main Methods:

  • Systematic search of multiple databases (CENTRAL, MEDLINE, Embase) and trial registers up to June 2018.
  • Inclusion of various study designs (RCTs, CBA, ITS) comparing P4P to basic payment schemes.
  • Narrative synthesis of findings due to study heterogeneity, with GRADE certainty assessment.

Main Results:

  • 27 studies evaluated six P4P programs, primarily in the USA, England, and France.
  • Most P4P programs demonstrated no or very small effects on quality, patient outcomes, or resource use.
  • Evidence certainty was predominantly low to very low across all assessed P4P programs and outcomes.

Conclusions:

  • Uncertainty exists regarding the impact of P4P on patient outcomes, quality of care, equity, and resource use due to very low certainty evidence.
  • Non-payment strategies and incentives for quality attainment showed potentially greater effectiveness than bonuses.
  • P4P may achieve only small, short-term effects with additional payments, often proving non-sustainable.