Rosenthal Meredith B, Frank Richard G
Harvard University, USA.
Med Care Res Rev. 2006 Apr;63(2):135-57. doi: 10.1177/1077558705285291.
Despite more than a decade of bench-marking and public reporting of quality problems in the health care sector, changes in medical practice have been slow to materialize. To accelerate quality improvement, many private and public payers have begun to offer financial incentives to physicians and hospitals based on their performance on clinical and service quality measures. The authors review the empirical literature on paying for quality in health care and comparable interventions in other sectors. They find little evidence to support the effectiveness of paying for quality. The absence of findings for an effect may be attributable to the small size of the bonuses studied and the fact that payers often accounted for only a fraction of the targeted provider's panel. Even in non-health settings, however, where the institutional features are more favorable to a positive impact, the literature contains mixed results on the effectiveness of analogous pay-for-performance schemes.
尽管在医疗保健领域进行了十多年的质量问题对标和公开报告，但医疗实践的变革却迟迟未能实现。为了加速质量提升，许多私人和公共支付方已开始根据医生和医院在临床及服务质量指标上的表现，向他们提供经济激励。作者回顾了关于医疗保健领域质量付费及其他领域类似干预措施的实证文献。他们发现几乎没有证据支持质量付费的有效性。缺乏效果的研究结果可能归因于所研究奖金规模较小，以及支付方通常仅占目标提供者患者群体的一小部分这一事实。然而，即便在机构特征更有利于产生积极影响的非医疗环境中，文献对于类似绩效薪酬方案的有效性也给出了喜忧参半的结果。
