Key issues in the design of pay for performance programs.
Key issues in the design of pay for performance programs.
复制标题
DOI：
10.1007/s10198-011-0347-6
复制
发表时间：
2013-02
影响因子：
4.4
通讯作者：
Eijkenaar, Frank
中科院分区：
文献类型：
--
作者：
Eijkenaar, Frank
按绩效付费 (P4P) 越来越多地被用来刺激医疗保健提供者提高绩效。然而，关于 P4P 有效性的证据仍无定论。程序设计中的缺陷可能导致了这种有限的成功。本文在综合相关理论和实证文献的基础上，讨论了P4P程序设计的关键问题。分析表明，设计一个公平有效的计划是一项复杂的任务。得出以下初步结论：（1）理想情况下，绩效的定义是宽泛的，前提是这组衡量指标仍然可以理解；（2）不应忽视 P4P 鼓励“选择”和“应试教学”的担忧；（3）复杂的风险调整很重要，特别是在结果和资源使用衡量方面；（4）让提供者参与项目设计至关重要；（5）总的来说，群体激励优于个人激励；（6）是否使用奖励或惩罚取决于具体情况， (7) 支付应该频繁且低效，(8) 绝对目标通常优于相对目标，(9) 多个目标优于单一目标，(10) P4P 应成为提供商薪酬的永久组成部分，并且最好与基本支付“脱钩”。但P4P方案的设计应根据实施的具体情况进行调整，并需要实证研究来证实结论。
Pay for performance (P4P) is increasingly being used to stimulate healthcare providers to improve their performance. However, evidence on P4P effectiveness remains inconclusive. Flaws in program design may have contributed to this limited success. Based on a synthesis of relevant theoretical and empirical literature, this paper discusses key issues in P4P-program design. The analysis reveals that designing a fair and effective program is a complex undertaking. The following tentative conclusions are made: (1) performance is ideally defined broadly, provided that the set of measures remains comprehensible, (2) concerns that P4P encourages “selection” and “teaching to the test” should not be dismissed, (3) sophisticated risk adjustment is important, especially in outcome and resource use measures, (4) involving providers in program design is vital, (5) on balance, group incentives are preferred over individual incentives, (6) whether to use rewards or penalties is context-dependent, (7) payouts should be frequent and low-powered, (8) absolute targets are generally preferred over relative targets, (9) multiple targets are preferred over single targets, and (10) P4P should be a permanent component of provider compensation and is ideally “decoupled” form base payments. However, the design of P4P programs should be tailored to the specific setting of implementation, and empirical research is needed to confirm the conclusions.
登录
查看更多内容
影响因子：
3.4
作者：
Chung, Sukyung;Palaniappan, Latha;Luft, Harold
通讯作者：
Luft, Harold
影响因子：
9.7
作者：
Enthoven, AC;Tollen, LA
通讯作者：
Tollen, LA
影响因子：
3.5
作者：
Eggleston, K
通讯作者：
Eggleston, K
影响因子：
120.7
作者：
DONABEDIAN, A
通讯作者：
DONABEDIAN, A
影响因子：
158.5
作者：
Adams, John L.;Mehrotra, Ateev;McGlynn, Elizabeth A.
通讯作者：
McGlynn, Elizabeth A.