The impact of pay-for-performance on the quality of care in ophthalmology: Empirical evidence from Germany. Issue 6 (June 2018)

• Record Type: Journal Article
• Authors: Herbst, T.; Foerster, J.; Emmert, M.
• Is Part Of: Health policy. Volume 122:Issue 6(2018)
• Page Start: 667
• Page End: 673
• Publication Date: 2018-06
• Subjects: Pay-for-performance -- P4P -- Ophthalmology -- Quality-based reimbursement -- Outcome quality; Medical education -- Periodicals; Medical policy -- Periodicals; Delivery of Health Care -- Periodicals; Education, Medical -- Periodicals; Health Education -- Periodicals; Health Planning -- Periodicals; Public Policy -- Periodicals; Enseignement médical -- Périodiques; Politique sanitaire -- Périodiques; Medical education; Medical policy; Periodicals; Electronic journals; Electronic journals; 362.1
• DOI: 10.1016/j.healthpol.2018.03.013
• Languages: English
• ISSNs: 0168-8510

Abstract

Highlights: So far, empirical evidence regarding P4P in ophthalmology is limited. P4P implementation did not lead to significant effects on the quality of care. No significant differences were found between P4P and lump-sum reimbursement schemes. Abstract: Background: Pay-for-performance (P4P) has become a popular approach to increase effectiveness and efficiency in healthcare. So far, there is little evidence regarding the potential of P4P in the German healthcare setting. The aim of this study was to determine the impact of P4P on the quality of care in cataract surgery. Methods: In 2012, a P4P program was implemented in a German surgical centre for ophthalmology. Five quality measures regarding process quality, outcomes, and patient satisfaction were measured over a period of 4.5 years. The P4P scheme consisted of bonus and penalty payments accounting for five per cent of total compensation. Overall, 1657 P4P cases were examined and compared with 4307 control cases. Interrupted time series and group comparisons were conducted to identify quality and spill-over effects. Results: We found a positive impact on process quality and patient satisfaction before the implementation of the P4P scheme, but declining trends during and after the implementation. Our findings did not show an impact of P4P on outcome measures. Furthermore, P4P did not result in better quality of care, compared with the German hospital-based reimbursement scheme. Conclusion: This study did not show any positive long-term effects of the implementation of P4P on quality of care. Therefore, our results do not support the hypothesis that P4P leads to significant improvements in quality of care.