scholarly journals Pay‐for‐performance and dental procedures: A longitudinal analysis of the Brazilian Program for the Improvement of Access and Quality of Dental Specialities Centres

2021 ◽  
Vol 50 (1) ◽  
pp. 4-10
Author(s):  
Fabiana da Silva Cabreira ◽  
Fernando Neves Hugo ◽  
Roger Keller Celeste
Keyword(s):  
Longitudinal Analysis ◽  
Pay For Performance ◽  
Dental Procedures ◽  
Access And Quality

scholarly journals Primary Care Doctors’ Assessment of and Preferences on Their Remuneration

2017 ◽  
Vol 54 ◽  
pp. 004695801769227 ◽  
Author(s):  
Stefanos Karakolias ◽  
Catherine Kastanioti ◽  
Mamas Theodorou ◽  
Nikolaos Polyzos
Keyword(s):  
Primary Care ◽  
Pay For Performance ◽  
Negative Impact ◽  
International Standards ◽  
Fee For Service ◽  
Policy Makers ◽  
Primary Care Doctors ◽  
Access And Quality ◽  
Dual Employment

Despite numerous studies on primary care doctors’ remuneration and their job satisfaction, few of them have quantified their views and preferences on certain types of remuneration. This study aimed at reporting these views and preferences on behalf of Greek doctors employed at public primary care. We applied a 13-item questionnaire to a random sample of 212 doctors at National Health Service health centers and their satellite clinics. The results showed that most doctors deem their salary lower than work produced and lower than that of private sector colleagues. Younger respondents highlighted that salary favors dual employment and claim of informal fees from patients. Older respondents underlined the negative impact of salary on productivity and quality of services. Both incentives to work at border areas and choose general practice were deemed unsatisfactory by the vast majority of doctors. Most participants desire a combination of per capita fee with fee-for-service; however, 3 clusters with distinct preferences were formed: general practitioners (GPs) of higher medical grades, GPs of the lowest medical grade, residents and rural doctors. Across them, a descending tolerance to salary-free schemes was observed. Greek primary care doctors are dissatisfied with the current remuneration scheme, maybe more than in the past, but notably the younger doctors are not intended to leave it. However, Greek policy makers should experiment in capitation for more tolerable to risk GPs and introduce pay-for-performance to achieve enhanced access and quality. These interventions should be combined with others in primary care’s new structure in an effort to converge with international standards.

Building research capacity and capabilities in Fiji: are we there yet?

2020 ◽  
Vol 21 (5) ◽  
pp. 265-271
Author(s):  
Jyotishna Mudaliar ◽  
Bridget Kool ◽  
Janice Natasha ◽  
Judith McCool
Keyword(s):  
Low Income ◽  
Research Capacity ◽  
Research Knowledge ◽  
Research Skills ◽  
Research Findings ◽  
Access And Quality ◽  
The University ◽  
Local Investigator ◽  
Research Capacity Development

Introduction: A barrier to local investigator-led research in low income settings, is the limited availability of personnel with appropriate research skills or qualifications to conduct the type of research required for evidence-informed policy making to improve access and quality of health care. In response to this, Fiji National University’s College of Medicine, Nursing and Health Sciences in Fiji, collaborated with academics based at the University of Auckland, New Zealand to deliver a series of research capacity development workshops in Fiji. Methods: Participants who attended any of the nine workshops (n=123) were contacted via email to take part in a brief survey regarding their perceptions of the effectiveness of the research capacity building workshops. Of the possible 123 participants, 80% (n=76) completed the questionnaire.  Results: Findings demonstrate that the majority of participants reported that they had gained research skills from the workshops (75%) including proposal development skills (68%) and knowledge of appropriate research methods (59%). Furthermore, 70% agreed that the workshops built their research confidence.  Since attending a workshop, 18% of respondents had successfully applied and received funding for research grants and/or fellowships.  Barriers to conduct research included workload (75%), lack of research knowledge, experience or skills (51%), and lack of institutional support (41%). Suggestions for future workshops included: more focus on data analysis, regular courses rather than ‘one offs’, and preparation of research findings (e.g. publications). Conclusion: Our findings indicate that research workshops of this nature may increase individual research capabilities but sustained, locally led initiatives, backed by institutional and supplementary technical support are essential.

Medicare’s Hospital Value-Based Purchasing Program Values Quality over QALYs

2021 ◽  
pp. 0272989X2110171
Author(s):  
Edward C. Norton ◽  
Jun Li ◽  
Anup Das ◽  
Andrew M. Ryan ◽  
Lena M. Chen
Keyword(s):  
Quality Of Care ◽  
Pay For Performance ◽  
Health Interventions ◽  
Quality Adjusted Life Years ◽  
Value Based Purchasing ◽  
Quality Performance ◽  
Life Years ◽  
Policy Adjustments ◽  
Quality Adjusted Life

Medicare’s Hospital Value-Based Purchasing Program (HVBP) is the first national pay-for-performance program to combine measures of quality of care with a measure of episode spending. We estimated the implicit tradeoffs between mortality reduction and spending reduction. To earn points in HVBP, a hospital can either lower mortality or reduce spending, creating a tradeoff between the 2 measures. We analyzed the quality performance and earned points of 2814 hospitals using publicly available data. We then quantified the tradeoffs between spending and mortality in terms of quality-adjusted life-years (QALYs). If incentives in the program were balanced, then the tradeoff between spending and QALYs should be comparable with those of high-value health interventions, roughly $50,000 to $200,000 per QALY. Instead, the tradeoff in HVBP was about $1.2 million per QALY. HVBP overvalues improvements in quality of care relative to spending reductions. We propose 2 possible policy adjustments that could improve incentives for hospitals to deliver high-value care.

scholarly journals Factors Associated with Health-Related Quality of Life in Psoriatic Arthritis Patients: A Longitudinal Analysis

2021 ◽  
Author(s):  
Dalifer Freites Nuñez ◽  
Alfredo Madrid-García ◽  
Leticia Leon ◽  
Gloria Candelas ◽  
Mercedes Núñez ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Psoriatic Arthritis ◽  
Longitudinal Analysis ◽  
Health Related Quality ◽  
Factors Associated ◽  
Related Quality ◽  
Health Related

Interventions Aimed at Reducing Use of Low-Value Health Services: A Systematic Review

2016 ◽  
Vol 74 (5) ◽  
pp. 507-550 ◽  
Author(s):  
Carrie H. Colla ◽  
Alexander J. Mainor ◽  
Courtney Hargreaves ◽  
Thomas Sequist ◽  
Nancy Morden
Keyword(s):  
Performance Feedback ◽  
Risk Sharing ◽  
Pay For Performance ◽  
Clinical Decision ◽  
Evidence Base ◽  
Provider Education ◽  
Rigorous Evaluation ◽  
And Performance ◽  
Multicomponent Interventions

The effectiveness of different types of interventions to reduce low-value care has been insufficiently summarized to allow for translation to practice. This article systematically reviews the literature on the effectiveness of interventions to reduce low-value care and the quality of those studies. We found that multicomponent interventions addressing both patient and clinician roles in overuse have the greatest potential to reduce low-value care. Clinical decision support and performance feedback are promising strategies with a solid evidence base, and provider education yields changes by itself and when paired with other strategies. Further research is needed on the effectiveness of pay-for-performance, insurer restrictions, and risk-sharing contracts to reduce use of low-value care. While the literature reveals important evidence on strategies used to reduce low-value care, meaningful gaps persist. More experimentation, paired with rigorous evaluation and publication, is needed.

scholarly journals Migration infrastructures and the production of migrants’ irregularity in Japan and the United Kingdom

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Nando Sigona ◽  
Jotaro Kato ◽  
Irina Kuznetsova
Keyword(s):  
Legal Status ◽  
Qualitative Interviews ◽  
Legal Violence ◽  
The United Kingdom ◽  
The Social ◽  
Access And Quality ◽  
The Uk ◽  
The Impact

AbstractThe article examines the migration infrastructures and pathways through which migrants move into, through and out of irregular status in Japan and the UK and how these infrastructures uniquely shape their migrant experiences of irregularity at key stages of their migration projects.Our analysis brings together two bodies of migration scholarship, namely critical work on the social and legal production of illegality and the impact of legal violence on the lives of immigrants with precarious legal status, and on the role of migration infrastructures in shaping mobility pathways.Drawing upon in-depth qualitative interviews with irregular and precarious migrants in Japan and the UK collected over a ten-year period, this article develops a three-pronged analysis of the infrastructures of irregularity, focusing on infrastructures of entry, settlement and exit, casting a comparative light on the mechanisms that produce precarious and expendable migrant lives in relation to access to labour and labour conditions, access and quality of housing and law enforcement, and how migrants adapt, cope, resist or eventually are overpowered by them.

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