Weissman Joel S, Hasnain-Wynia Romana, Weinick Robin M, Kang Raymond, Vogeli Christine, Iezzoni Lisa, Landrum Mary Beth
Institute for Health Policy, Massachusetts General Hospital, MA, USA.
J Health Care Poor Underserved. 2012 Feb;23(1):144-60. doi: 10.1353/hpu.2012.0030.
Pay-for-performance (P4P) programs may have unintended effects on racial/ethnic disparities. We used patient-level quality scores from the Hospital Quality Alliance and ranked hospitals by overall quality and by racial/ethnic disparities. We then modeled the effects of different P4P designs on national disparity scores. The models using overall quality to rank hospitals resulted in modest reductions in national disparity scores, although these were smaller than the reductions that were found from programs using disparities to rank hospitals. These results suggest that many hospitals treat Whites and minorities equitably. Nevertheless, in order to maximize both improvements in quality and reductions in national disparities, P4P programs should consider an approach that considers both overall quality and reductions in disparities when setting incentives.
绩效薪酬（P4P）计划可能会对种族/民族差异产生意想不到的影响。我们使用了医院质量联盟的患者层面质量得分，并根据整体质量和种族/民族差异对医院进行排名。然后，我们模拟了不同P4P设计对全国差异得分的影响。使用整体质量对医院进行排名的模型使全国差异得分略有降低，尽管这些降幅小于使用差异对医院进行排名的计划所发现的降幅。这些结果表明，许多医院公平地对待白人和少数族裔。然而，为了在提高质量和减少全国差异方面都取得最大成效，P4P计划在设定激励措施时应考虑一种兼顾整体质量和减少差异的方法。
