Pay-for-performance schemes in primary care: what have we learnt?

2018 ◽  
pp. 137-146
Author(s):  
Stephen Peckham ◽  
Andrew Wallace
Keyword(s):  
Primary Care ◽  
Pay For Performance

scholarly journals Primary care organizational model mix and avoidable hospitalization: an ecological study in Portugal

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Pinto ◽  
J V Santos ◽  
M Lobo ◽  
J Viana ◽  
J Souza ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Primary Healthcare ◽  
Pay For Performance ◽  
Care Quality ◽  
Organizational Model ◽  
Avoidable Hospitalizations ◽  
Primary Health ◽  
Age And Sex

Abstract Background In Portugal, there are different organizational models in primary health care (PHC), mainly regarding the payment scheme. USF-B is the only type with financial incentives to the professional (pay-for-performance). Our goal was to assess the relationship between groups of primary healthcare centres (ACES) with higher proportion of patients within USF-B model and the rate of avoidable hospitalizations, as proxy of primary care quality. Methods We conducted a cross-sectional study considering the 55 ACES from mainland Portugal, in 2017. We used data from public hospitalizations to calculate the prevention quality indicator (avoidable hospitalizations) adjusted for age and sex, using direct standardization. The main independent variable was the proportion of patients in one ACES registered in the USF-B model. Unemployment rate, proportion of patients with family doctor and presence of Local Health Unit (different organization model) within ACES were also considered. The association was assessed by means of a linear regression model. Results Age-sex adjusted PQI value varied between 490 and 1715 hospitalizations per 100,000 inhabitants across ACES. We observed a significant effect of the proportion of patients within USF-B in the crude PQI rate (p = 0.001). However, using the age-sex adjusted PQI, there was not a statistical significant association (p = 0.504). This last model was also adjusted for confounding variables and the association remains non-significant (p = 0.865). Conclusions Our findings suggest that, when adjusting for age and sex, there is no evidence that ACES with more patients enrolled in a pay-for-performance model is associated with higher quality of PHC (using avoidable hospitalizations as proxy). Further studies addressing individual data should be performed. This work was financed by FEDER funds through the COMPETE 2020 - POCI, and by Portuguese funds through FCT in the framework of the project POCI-01-0145-FEDER-030766 “1st.IndiQare”. Key messages Adjusting PQI to sex and age seems to influence its value more than the type of organizational model of primary health care. Groups of primary healthcare centres with more units under the pay-for-performance scheme was not associated with different rate of avoidable hospitalizations.

scholarly journals Patients' views of pay for performance in primary care: a qualitative study

2012 ◽  
Vol 62 (598) ◽  
pp. e322-e328 ◽  
Author(s):  
Kerin L Hannon ◽  
Helen E Lester ◽  
Stephen M Campbell
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Pay For Performance

scholarly journals The UK pay-for-performance programme in primary care: estimation of population mortality reduction

2010 ◽  
Vol 60 (578) ◽  
pp. e345-e352 ◽  
Author(s):  
Robert Fleetcroft ◽  
Sheetal Parekh-Bhurke ◽  
Amanda Howe ◽  
Richard Cookson ◽  
Louise Swift ◽  
...  
Keyword(s):  
Primary Care ◽  
Pay For Performance ◽  
Mortality Reduction ◽  
Population Mortality ◽  
The Uk

Quality of Primary Care in England with the Introduction of Pay for Performance

2007 ◽  
Vol 357 (2) ◽  
pp. 181-190 ◽  
Author(s):  
Stephen Campbell ◽  
David Reeves ◽  
Evangelos Kontopantelis ◽  
Elizabeth Middleton ◽  
Bonnie Sibbald ◽  
...  
Keyword(s):  
Primary Care ◽  
Pay For Performance ◽  
Quality Of Primary Care

scholarly journals Impact of a national primary care pay-for-performance scheme on ambulatory care sensitive hospital admissions: a small-area analysis in England

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e036046
Author(s):  
Christos Grigoroglou ◽  
Luke Munford ◽  
Roger Webb ◽  
Navneet Kapur ◽  
Tim Doran ◽  
...  
Keyword(s):  
Primary Care ◽  
Ambulatory Care ◽  
Small Area ◽  
Negative Binomial ◽  
Hospital Admissions ◽  
Pay For Performance ◽  
Administrative Dataset ◽  
Practice Performance ◽  
Quality And Outcomes ◽  
Ambulatory Care Sensitive

ObjectiveWe aimed to spatially describe hospital admissions for ambulatory care sensitive conditions (ACSC) in England at small-area geographical level and assess whether recorded practice performance under one of the world’s largest primary care pay-for-performance schemes led to reductions in these potentially avoidable hospitalisations for chronic conditions incentivised in the scheme.SettingWe obtained numbers of ACSC hospital admissions from the Hospital Episode Statistics database and information on recorded practice performance from the Quality and Outcomes Framework (QOF) administrative dataset for 2015/2016. We fitted three sets of negative binomial models to examine ecological associations between incentivised ACSC admissions, general practice performance, deprivation, urbanity and other sociodemographic characteristics.ResultsHospital admissions for QOF incentivised ACSCs varied within and between regions, with clusters of high numbers of hospital admissions for incentivised ACSCs identified across England. Our models indicated a very small effect of the QOF on reducing admissions for incentivised ACSCs (0.993, 95% CI 0.990 to 0.995), however, other factors, such as deprivation (1.021, 95% CI 1.020 to 1.021) and urbanicity (0.875, 95% CI 0.862 to 0.887), were far more important in explaining variations in admissions for ACSCs. People in deprived areas had a higher risk of being admitted in hospital for an incentivised ACSC condition.ConclusionSpatial analysis based on routinely collected data can be used to identify areas with high rates of potentially avoidable hospital admissions, providing valuable information for targeting resources and evaluating public health interventions. Our findings suggest that the QOF had a very small effect on reducing avoidable hospitalisation for incentivised conditions. Material deprivation and urbanicity were the strongest predictors of the variation in ACSC rates for all QOF incentivised conditions across England.

scholarly journals Az indikátoralapú teljesítményértékelésre épülő forráselosztás hatékonysága Magyarországon a felnőtteket ellátó háziorvosi praxisokban

2019 ◽  
Vol 160 (39) ◽  
pp. 1542-1553
Author(s):  
Anita Pálinkás ◽  
Nóra Kovács ◽  
Valéria Sipos ◽  
Ferenc Vincze ◽  
Magor Papp ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
Performance Monitoring ◽  
Pay For Performance ◽  
Structural Characteristics ◽  
Statistical Testing ◽  
Present System ◽  
Medical Practices ◽  
Adjusted Indicators ◽  
Better Than

Abstract: Introduction: The indicator-based performance monitoring and pay-for-performance system for Hungarian primary care was established in 2009, covering the whole country. It is based on a stable legal system and well operating information technology. Although, the health insurance system is able to facilitate the performance improvement only by the financing for general medical practices, the many times modified present system does not take into consideration (apart from the geographical location of practices) factors which determine the performance but cannot be influenced by general practitioners. Aim: The study aimed at renewing the indicator set and evaluation methodology in order to enable the monitoring to evaluate the performance of general medical practices independent of their structural characteristics. Method: Each adult care specific primary care performance indicator from June 2016 covering the whole country has been investigated. Indicators adjusted for structural practice characteristics (age and gender of patients; relative education of people provided; settlement type and county of the practice) have been computed. The difference between adjusted indicators and national reference values has been evaluated by statistical testing. Appropriateness of the present monitoring and financing system has been investigated by comparing the practice level presently applied and adjusted indicators to outline the opportunities to develop the present system. Results: The present monitoring allocates 34.46% of pay-for-performance resources for improving the performance of practices. The majority of resources supports the conservation of performance. Furthermore, the present system is not able to identify each practice with better than reference performance, withholding amount corresponding to 8.83% of pay-for-performance resources. If this financing were restricted to practices with significantly better than reference performance, the maximum of the financing a month in a practice would increase from 176 042 HUF (551 EURO) to 406 604 HUF (1274 EURO). Conclusion: Completing the performance monitoring system operated at present by the National Health Insurance Fund of Hungary with indicators adjusted for structural characteristics of the general medical practices, the resource allocation effectiveness could be improved. Orv Hetil. 2019; 160(39): 1542–1553.

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