Implementing pay-for-performance in Australian primary care: lessons from the United Kingdom and the United States
Implementing pay-for-performance in Australian primary care: lessons from the United Kingdom and the United States
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DOI：
10.5694/j.1326-5377.2010.tb03971.x
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发表时间：
2010-10-04
影响因子：
11.4
通讯作者：
Sivey, Peter M.
中科院分区：
文献类型：
--
作者：
Campbell, Stephen M.;Scott, Anthony;Sivey, Peter M.
我们从绩效工资的国际经验中找出关键的经验教训，并利用它们来制定澳大利亚在引入此类计划之前要考虑的问题。对经验教训的讨论是基于对文献的叙述性回顾。我们审查了设计按绩效工资计划时需要考虑的因素的国际证据，以及这些计划对初级保健从业人员行为和初级保健资金的影响。按业绩付费计划随着时间的推移而演变，通常涉及几个复杂的干预措施，包括认证、教育、质量改进计划、信息技术和数据收集系统的投资、专业支持和区域结构。这些都是将经济激励与护理质量挂钩的必要条件。有一个强有力的论点是，应该改变现有的服务激励支付计划，并将资源投资于修订后的结果支付，以奖励每年接受完整护理周期的患者数量的改善。如果澳大利亚要引入按绩效付费，应该从其他国家的经验中吸取几个关键教训。绩效工资应被用作质量改进的更广泛战略的一部分；它不应被视为灵丹妙药。绩效工资应该用来推动质量改进，而不是简单地奖励那些已经提供高质量医疗服务的人。
We identify key lessons learned from the international experience of pay-for-performance and use them to formulate questions for Australia to consider before such a scheme is introduced.Discussion of lessons learned is based on a narrative review of the literature.We examined international evidence on factors to consider when designing pay-for-performance schemes, and the impact of these schemes on primary care practitioner behaviour and on primary care funding.Pay-for-performance schemes evolve over time, and usually involve several complex interventions including accreditation, education, quality improvement programs, investment in information technology and data collection systems, professional support and regional structures. These are all necessary conditions for linking financial incentives to quality of care.There is a strong argument for changing the existing service incentive payments program and investing the resources into revised outcome payments that provide rewards for annual improvements in numbers of patients receiving completed cycles of care.If pay-for-performance is to be introduced in Australia, several key lessons should be learned from the experiences of other countries. Pay-for-performance should be used as part of a wider strategy for quality improvement; it should not be seen as a panacea. Pay-for-performance should be used to drive quality improvement, not simply to reward those who are already providing high-quality care.