Financial Incentives And Measurement Improved Physicians' Quality Of Care In The Philippines
Financial Incentives And Measurement Improved Physicians' Quality Of Care In The Philippines
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DOI：
10.1377/hlthaff.2009.0782
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发表时间：
2011-04-01
期刊：
影响因子：
9.7
通讯作者：
Solon, Orville
中科院分区：
文献类型：
--
作者：
Peabody, John;Shimkhada, Riti;Solon, Orville
使用经济激励来提高临床质量的优点很有吸引力，但很少有研究严格评估其潜在的好处。围绕质量评估的不确定性可能导致糟糕的政策决策，可能导致成本增加，质量改善很少或根本没有改善，或错过改善护理的机会。我们进行了一项实验，涉及30家菲律宾医院的医生，克服了许多以前研究的局限性。我们衡量了临床表现，然后研究了相当于医生工资5%左右的适度奖金，以及增加医院和医生群体薪酬的系统级激励措施，是否会导致医疗质量的改善。我们发现，奖金和系统层面的激励措施都使我们研究中使用的质量测量系统的得分提高了10个百分点。我们的研究结果表明，当仔细测量与我们研究的激励类型相结合时，可能会对质量产生比以前认识到的更大的影响。
The merits of using financial incentives to improve clinical quality have much appeal, yet few studies have rigorously assessed the potential benefits. The uncertainty surrounding assessments of quality can lead to poor policy decisions, possibly resulting in increased cost with little or no quality improvement, or missed opportunities to improve care. We conducted an experiment involving physicians in thirty Philippine hospitals that overcomes many of the limitations of previous studies. We measured clinical performance and then examined whether modest bonuses equal to about 5 percent of a physician's salary, as well as system-level incentives that increased compensation to hospitals and across groups of physicians, led to improvements in the quality of care. We found that both the bonus and system-level incentives improved scores in a quality measurement system used in our study by ten percentage points. Our findings suggest that when careful measurement is combined with the types of incentives we studied, there may be a larger impact on quality than previously recognized.