Advocates for Evidence-Based Health Policy Speakers
P4P Reduced Mortality in UK
Pay-for-performance has demonstrated mixed results in the US. A recent UK study shows promise for success.
Programs that provide financial bonuses to hospitals that produce desired health outcomes are known as ‘pay-for-performance’ (P4P). However, evidence to date does not link pay-for-performance to effects on critically important patient outcomes. The researchers of this study sought to define how pay-for-performance affects mortality outcomes in an inpatient setting in one region in England.
They evaluated 30-day mortality during hospitalizations of 135,000 patients admitted for pneumonia, heart failure, or acute myocardial infarction 18 months before and 18 months after the introduction of pay-for-performance in 24 hospitals in a northwest region of England. Comparisons were made amongst patients with the same conditions in other hospitals in England not using a pay-for-performance system as well as comparisons amongst patients with 6 other conditions at all hospitals. The patients studied were similarly matched over time in all populations for age, coexisting conditions, and patient volumes.
The authors found that the introduction of pay-for-performance was associated with a reduction in the combined mortality of 1.3% points related to pneumonia, heart failure, and acute myocardial infarction. The largest mortality reduction was related to pneumonia. The researchers concluded that pay-for-performance was associated with a clinically significant reduction in mortality.
Commentary
When compared to similar pay-for-performance programs in the United States, the researcher team for this study concluded that the improved effect of pay-for-performance on patient outcomes in England may be related to the fact that the UK program had larger bonuses and a greater investment by hospitals in quality-improvement activities. Careful examination of this difference is important.
Similar to pay-for-performance, the managed care concept from several decades ago gave doctors the opportunity to earn more financially by lowering overall costs (via limiting care). But, managed care failed to produce the desired results on a national scale, with doctors complaining that they were unable to make the best medical decisions and patients complaining that they were losing access to needed services.
As American policy makers and health care payers continue to search for the ‘triple aim’ (improved quality for patients, better population health, and lower costs), a better understanding of what works with pay-for-performance incentives and what does not is critical to avoid repeating the managed care mistakes of the past.
by
Jennifer Shine Dyer, MD, MPH