Peckham Stephen, Wallace Andrew
Reader in Health Policy, Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK.
Qual Prim Care. 2010;18(2):111-6.
Pay for performance (P4P) schemes have become increasingly popular innovations in primary care and have generated questions about their effect on improving quality of care.
To provide a brief outline of the international evidence on the relationship between P4P schemes and quality improvement.
We conducted a literature search using relevant databases and reference lists of retrieved articles which discussed P4P schemes, quality in primary care and the Quality and Outcomes Framework (QOF). These included two recent systematic reviews of P4P schemes.
Evidence on the effect of P4P on quality is limited. What we can say is that P4P schemes can have an effect on the behaviour of physicians and can lead to better clinical management of disease, but that there is cause for concern about the impact on the quality of care.
P4P schemes need to take more account of broader definitions of quality, as whilst they can have a positive impact on incentivised clinical processes, it is not clear that this translates into improving the experience and outcome of care.
绩效薪酬（P4P）计划已成为基层医疗中越来越受欢迎的创新举措，并引发了关于其对改善医疗质量影响的问题。
简要概述关于P4P计划与质量改进之间关系的国际证据。
我们使用相关数据库以及检索到的讨论P4P计划、基层医疗质量和质量与结果框架（QOF）的文章的参考文献列表进行了文献检索。这些检索包括最近两项关于P4P计划的系统评价。
关于P4P对质量影响的证据有限。我们可以说的是，P4P计划会对医生的行为产生影响，并能带来更好的疾病临床管理，但对医疗质量的影响令人担忧。
P4P计划需要更多地考虑质量的更广泛定义，因为虽然它们可以对激励的临床过程产生积极影响，但尚不清楚这是否转化为改善医疗体验和结果。
