The impact of pay-for-performance on the quality of care in ophthalmology: Empirical evidence from Germany |
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| Institution: | 1. nordBLICK Augenklinik Bellevue, Lindenallee 21-23, 24105 Kiel, Germany;2. Friedrich-Alexander-University Erlangen-Nuremberg, School of Business and Economics, Institute of Management (IFM), Lange Gasse 20, 90403 Nuremberg, Germany;1. Health Metrics, The Sahlgrenska Academy, University of Gothenburg, Box 414, SE 405 30, Gothenburg, Sweden;2. Department of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden;1. Hacettepe University Faculty of Medicine, Department of Public Health, 06100, Ankara, Turkey;2. Hacettepe University Institute of Public Health, 06100, Ankara, Turkey;1. Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, via Roentgen, 1, 20136, Milano, Italy;2. Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University, Università del Piemonte Orientale, Largo Donegani, 2/3, 28100, Novara, Italy;1. Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI;2. Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX;3. Michigan Value Collaborative, Ann Arbor, MI;4. Department of Surgery, University of Michigan Medical School, Ann Arbor, MI;5. Department of Orthopedic Surgery, University of Michigan Medical School, Ann Arbor, MI;1. Centre for Health Economics, University of York, Heslington, York, YO10 5DD, United Kingdom;2. Department of Health Sciences, University of York, United Kingdom;3. Centre for Health Economics, University of York, United Kingdom;4. Alliance Manchester Business School, University of Manchester, United Kingdom;1. Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania;2. Division of Pediatric Ophthalmology, The Children''s Hospital of Philadelphia, Philadelphia, Pennsylvania;3. Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland;4. Dean McGee Eye Institute, University of Oklahoma, Oklahoma City;5. Department of Ophthalmology, University of Utah, Salt Lake City;6. Department of Ophthalmology, Vanderbilt University, Nashville, Tennessee;7. National Eye Institute, Bethesda, Maryland;8. Department of Ophthalmology, University of Calgary, Canada;9. Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina |
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| Abstract: | BackgroundPay-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.MethodsIn 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.ResultsWe 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.ConclusionThis 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. |
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| Keywords: | Pay-for-performance P4P Ophthalmology Quality-based reimbursement Outcome quality |
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