Preliminary investigation into general practitioners' willingness to accept the pay-for-performance scheme: A replication study

PurposePolicymakers implementing pay-for-performance schemes within general practice should seek to design schemes which work with rather than against the professional values and goals of general practitioners. In this way, schemes are more likely to enhance the practitioners' engagement. The purpose of this paper is to show how this was done in two case studies of pay-for-performance design and present the lessons from this study for policymakers.Design/methodology/approachA Most Similar Systems collective case study of the design of two pay-for-performance schemes for general practitioners, the United Kingdom's Quality and Outcomes Framework (QOF) and the New Zealand’s Performance Management Programme (PMP) was undertaken, involving 26 semi-structured interviews with policymakers, documentary and literature analysis.FindingsInnovation in processes was found in both case studies which facilitated engagement by general practitioners in the formulation and implementation of these schemes. These were careful selection of highly skilled design teams, use of principle-based negotiation techniques and academic mediation of indicator selection. In addition, in England the majority of members in the combined QOF design team were general practitioners. The evidence from these two case studies reinforces approaches to scheme design which seek to harness rather than challenge medical professional values and which maximise the participation of general practitioners in the design process. Achieving funder/practitioner collaboration should be a key goal in the policymaking process.Practical implicationsPay-for-performance scheme designers can improve their ability to engage general practitioners in scheme design and scheme uptake by adopting approaches which actively engage general practitioners as designers and users of such schemes.Originality/valueThis study compares two contemporaneous processes of pay-for-performance scheme design and implementation in similar systems of general practice funding and delivery at the national level, offering a rare quasi-experimental opportunity for learning lessons from comparative analysis.

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Pay for performance scheme for general practitioners in France: results in 2018

European Journal of Public Health ◽

10.1093/eurpub/ckz187.147 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

A A Atramont ◽

S C Coffy ◽

S S Sebo ◽

G D Debeugny

Keyword(s):

Chronic Diseases ◽

General Practitioners ◽

Pay For Performance ◽

Generic Drugs ◽

National Health System ◽

Diabetic Patients ◽

Fee For Service ◽

Medical Practices ◽

Diabetic Retinopathy Screening ◽

Lump Sum

Abstract Methods A pay-for-performance scheme, known as Remuneration on public health objectives (ROSP) and based on meeting targets on quality and efficiency indicators, was introduced for general practitioners in France in 2012. Since 2017, following the 2016 medical agreement between Health Insurance and doctors’ unions, ROSP has consisted of 29 indicators: 8 about chronic disease management, 12 about prevention and 9 about appropriate and efficient prescriptions. The aim of this work was to describe the 2018 results and the overall evolution of the indicators for office-based practitioners. Data are from the French national health system database. Results Follow-up of diabetic patients is steady: diabetic retinopathy screening and regular HbA1c measurement have been performed in 63% and 79% of them since 2016, respectively. Screening for chronic kidney disease improved for diabetic patients (29% in 2015 to 39% in 2018) and hypertensive patients (6% to 11%) but remain low. Influenza vaccination among people over 65 years increased in 2018 (55%) while a downward trend has been observed since 2011 (58% in 2011, 53% in 2016). The number of antibiotic treatments has decreased since 2011, from 46 out of 100 adults without long-term disease to 36 in 2018. In contrast, breast cancer and cervical cancer screening indicators have stagnated for several years around 66% and 56%, respectively. In terms of efficiency, all the indicators improved, most of them consisting in biosimilar and generic drugs prescription. By 2018, ROSP represents 3% of doctors’ revenue (including fee-for-service and lump sum payments). Conclusions By promoting prevention, better management of chronic diseases and optimizing prescriptions in relation to standards, ROSP indicators contribute to improve medical practices. The indicators need to be regularly updated to take into account the evolution of practices and recommendations. Key messages By promoting prevention, better management of chronic diseases and optimizing prescriptions in relation to standards, ROSP indicators contribute to improve medical practices. The indicators need to be regularly updated to take into account the evolution of practices and recommendations.

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Exploring the Effectiveness of a P4P Scheme from the Italian General Practitioners’ Perspective: A Replication Study

10.21203/rs.3.rs-15709/v1 ◽

2020 ◽

Author(s):

MONICA GIANCOTTI ◽

MARIANNA MAURO ◽

FRANCESCO RANIA

Keyword(s):

General Practitioners ◽

Financial Incentives ◽

Pay For Performance ◽

Healthcare Providers ◽

Implementation Process ◽

Quality Of Healthcare ◽

Successful Implementation ◽

Performance Quality ◽

Italian Context

Abstract Background A major problem of the primary healthcare systems is represented by the deficiencies in performance quality. Financial incentives can be used in order to improve the quality of healthcare. According to this, since 1993 many countries have introduced pay for performance reimbursement schemes to encourage practitioner behaviour to align with the specific objectives of the decision maker and to incentivize the provision of targeted services. In this context the study of Krauth et al. (2016) was the first in Europe to determine whether general practitioners would participate in a pay for performance programme and under what conditions. Our research replicates the German survey, adjusting it to the Italian context. This article explores whether financial incentives can improve the quality of healthcare from the perspective of general practitioners. The purposes were as follows: to assess the attitudes of Italian general practitioners towards the current remuneration scheme; to determine if they would participate in a pay for performance programme; and to analyse how such views vary among the groups of respondents. Methods Our tool for data collection was a questionnaire elaborated on the basis of a theoretical framework developed by Krauth et al. The questionnaires were distributed from September to December 2017. Results Results confirm that for a successful implementation of a quality-based compensation scheme, it is crucial to gain the acceptance and support of healthcare providers. Conclusions To ensure that healthcare providers can realistically achieve the programme’s targets, they should be involved in the implementation process. Our study offers useful information for developing an effectiveness remuneration scheme in Italy for general practice.

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How French general practitioners adapt their care to patients with social difficulties?

Family Medicine and Community Health ◽

10.1136/fmch-2018-000044 ◽

2019 ◽

Vol 7 (4) ◽

pp. e000044

Author(s):

Annie De Oliveira ◽

Barbara Chavannes ◽

Magali Steinecker ◽

Mady Denantes ◽

Julie Chastang ◽

...

Keyword(s):

Primary Care ◽

Focus Groups ◽

General Practitioners ◽

Social Inequalities ◽

Pay For Performance ◽

Health Sector ◽

Primary Care Settings ◽

The Social ◽

Social Difficulties ◽

The Individual

ObjectiveSeveral studies have shown the role of the primary care system in access to care and in reducing social inequalities in health. The objective of this study was to describe the practices of general practitioners (GPs) in taking into account the social environment of their patient, and the ways they adapted to social difficulties.DesignQualitative study comprising interviews and focus groups.SettingFrench primary care settings.ParticipantsTwenty semistructured interviews and two focus groups were conducted with 33 GPs. Sessions were audio recorded, transcribed verbatim and analysed using thematic analysis. The reporting of findings was guided by consolidated criteria for reporting qualitative research.ResultThis study identified adaptations at three levels: in the individual management of patients (alert system, full involvement in prevention, better communication, prioritised additional examinations, financial facilities, help in administrative tasks), in the collective management of patients in an office (consultation without appointment, pay-for-performance indicators, medical staffs, multidisciplinary protocols, medical practice in group, medical student), and in the community management (patients description, cooperation with associations, public health sector and politics).ConclusionIn France, GPs can take into account the social determinants of health in practice through simple or more complex actions.

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