University of California, San Francisco, California, USA.
Health Aff (Millwood). 2011 Apr;30(4):773-81. doi: 10.1377/hlthaff.2009.0782.
The merits of using financial incentives to improve clinical quality have much appeal, yet few studies have rigorously assessed the potential benefits. The uncertainty surrounding assessments of quality can lead to poor policy decisions, possibly resulting in increased cost with little or no quality improvement, or missed opportunities to improve care. We conducted an experiment involving physicians in thirty Philippine hospitals that overcomes many of the limitations of previous studies. We measured clinical performance and then examined whether modest bonuses equal to about 5 percent of a physician's salary, as well as system-level incentives that increased compensation to hospitals and across groups of physicians, led to improvements in the quality of care. We found that both the bonus and system-level incentives improved scores in a quality measurement system used in our study by ten percentage points. Our findings suggest that when careful measurement is combined with the types of incentives we studied, there may be a larger impact on quality than previously recognized.
使用财务激励来提高临床质量具有很大的吸引力，但很少有研究严格评估其潜在益处。质量评估的不确定性可能导致糟糕的政策决策，这可能导致成本增加，而质量改善甚微，或者错失改善护理的机会。我们在 30 家菲律宾医院进行了一项实验，该实验克服了以往研究的许多局限性。我们衡量了临床绩效，然后研究了适度的奖金（相当于医生工资的 5%左右）以及增加医院和医生群体薪酬的系统激励是否会提高护理质量。我们发现，奖金和系统激励都使我们研究中使用的质量衡量系统的得分提高了 10 个百分点。我们的研究结果表明，当谨慎的衡量与我们研究的激励类型相结合时，对质量的影响可能比以前认识到的要大。
