BOSTON, Mass. (Jan. 26, 2011)As news outlets throughout Europe and the U.S. report on the plummeting health of Western adults and children, there is no shortage of culprits. One villain often bandied about is the "fee for service" system of incentives for physicians. Clearly, if doctors are financially rewarded for simply performing more procedures, costs will soar at the expense of patient health.
Enter Pay-for-Performance, an emerging movement in which physicians are rewarded not for what they do, but for quality of care and patient outcomes. Under such a system, economic logic dictates that patients should theoretically show marked improvements when doctors' incentives shift from procedure to patient.
This new approach was implemented in the United Kingdom in 2004 in a program termed "Quality and Outcomes Framework." But whether or not such an approach has actually improved patient health remains an open question.
A new study published January 26 in BMJ presents the strongest evidence yet that Pay-for-Performance does not offer any benefit to patients with hypertension, despite the enormous administrative costs required to maintain such a system.
"No matter how we looked at the numbers, the evidence was unmistakable; by no measure did pay-for-performance benefit patients with hypertension," says lead author Brian Serumaga, formerly of Harvard Medical School/Harvard Pilgrim Health Care Institute, but now at University of Nottingham Medical School.
Working closely with researchers at Harvard, Nottingham, and the University of Alberta in Canada, Serumaga and his colleagues focused on how Pay-for-Performance might affect outcomes in patients with hypertension, a condition where other interventions such as patient education have shown to be very effective.
Analyzing data from the UK's Health Improvement Network, a large database of primary care records from 358 UK general practices, the internation
|Contact: David Cameron|
Harvard Medical School