性能付费的设计是否重要? 来自巴西的证据
Letícia Xander Russo1, Timothy Powell-Jackson2, Josephine Borghi2
1Faculty of Business, Accounting and Economics, Federal University of Grande Dourados, Rodovia Dourados-Itahum, Km 12, Dourados, MS 79804-970, Brazil.
按绩效支付的计划显示出混合的结果. 这项研究发现,巴西的初级医疗保健团队经常获得更大的奖金.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 公共卫生政策 公共卫生政策
- 卫生经济学 卫生经济学
背景情况:
- 绩效支付 (P4P) 计划对医疗保健结果产生不一致的影响.
- P4P干预措施通常被视为统一的,尽管它们的设计有很大的差异.
- 了解特定的P4P设计元素对于有效实施至关重要.
研究的目的:
- 分析巴西国家P4P计划 (PMAQ) 中的激励设计变化.
- 探索不同P4P设计类型和初级医疗保健提供者的表现之间的关联.
- 为设计更有效的P4P倡议提供信息.
主要方法:
- 全国范围内对市卫生管理人员进行调查,以描述P4P计划设计.
- 分析奖金金额,奖励提供商和支付频率.
- OLS回归和集群分析以确定设计类型及其对家庭健康团队 (FHT) 绩效的影响.
主要成果:
- 频繁 (每月) 的奖金支付和更大的奖金分配 (20-80%的资金) 与更好的FHT业绩有关.
- 一个团队内的奖金的具体受益人并没有独立地影响表现.
- 一个结合了大额奖金,许多激励工人和高支付频率的集群表现明显更高 (21.7%的增长).
结论:
- 特定的P4P设计特征,特别是奖励频率和规模,显著影响医疗保健提供者的业绩.
- 设计特征的组合,而不是孤立的元素,是优化P4P有效性的关键.
- 调查结果提供了在初级保健中设计更具影响力的P4P计划的证据.
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