National Primary Care Research and Development Centre, University of Manchester, Manchester, UK.
Med J Aust. 2010 Oct 4;193(7):408-11. doi: 10.5694/j.1326-5377.2010.tb03971.x.
We identify key lessons learned from the international experience of pay-for-performance and use them to formulate questions for Australia to consider before such a scheme is introduced. Discussion of lessons learned is based on a narrative review of the literature. We examined international evidence on factors to consider when designing pay-for-performance schemes, and the impact of these schemes on primary care practitioner behaviour and on primary care funding. Pay-for-performance schemes evolve over time, and usually involve several complex interventions including accreditation, education, quality improvement programs, investment in information technology and data collection systems, professional support and regional structures. These are all necessary conditions for linking financial incentives to quality of care. There is a strong argument for changing the existing service incentive payments program and investing the resources into revised outcome payments that provide rewards for annual improvements in numbers of patients receiving completed cycles of care. If pay-for-performance is to be introduced in Australia, several key lessons should be learned from the experiences of other countries. Pay-for-performance should be used as part of a wider strategy for quality improvement; it should not be seen as a panacea. Pay-for-performance should be used to drive quality improvement, not simply to reward those who are already providing high-quality care.
我们从国际绩效薪酬经验中总结出关键教训，并利用这些教训来制定澳大利亚在引入此类计划之前需要考虑的问题。讨论经验教训的依据是对文献的叙述性回顾。我们研究了国际上在设计绩效薪酬计划时需要考虑的因素的证据，以及这些计划对初级保健医生行为和初级保健资金的影响。绩效薪酬计划随着时间的推移而不断发展，通常涉及几个复杂的干预措施，包括认证、教育、质量改进计划、投资信息技术和数据收集系统、专业支持和区域结构。所有这些都是将财务激励与护理质量联系起来的必要条件。有一个强有力的理由需要改变现有的服务激励支付计划，并将资源投入到修订后的成果支付中，为每年接受完成护理周期的患者人数增加提供奖励。如果要在澳大利亚引入绩效薪酬，应该从其他国家的经验中吸取以下关键教训。绩效薪酬应作为质量改进更广泛战略的一部分；不应将其视为万灵药。绩效薪酬应该用于推动质量改进，而不仅仅是奖励那些已经提供高质量护理的人。
