Meacock Rachel, Kristensen Søren Rud, Sutton Matt
Manchester Centre for Health Economics, Institute of Population Health, The University of Manchester, UK.
Health Econ. 2014 Jan;23(1):1-13. doi: 10.1002/hec.2978. Epub 2013 Aug 14.
Despite growing adoption of pay-for-performance (P4P) programmes in health care, there is remarkably little evidence on the cost-effectiveness of such schemes. We review the limited number of previous studies and critique the frameworks adopted and the narrow range of costs and outcomes considered, before proposing a new more comprehensive framework, which we apply to the first P4P scheme introduced for hospitals in England. We emphasise that evaluations of cost-effectiveness need to consider who the residual claimant is on any cost savings, the possibility of positive and negative spillovers, and whether performance improvement is a transitory or investment activity. Our application to the Advancing Quality initiative demonstrates that the incentive payments represented less than half of the £ 13 m total programme costs. By generating approximately 5200 quality-adjusted life years and £ 4.4 m of savings in reduced length of stay, we find that the programme was a cost-effective use of resources in its first 18 months.
尽管医疗保健领域采用绩效薪酬（P4P）计划的情况日益增多，但关于此类计划的成本效益的证据却非常少。在提出一个新的更全面的框架之前，我们回顾了以往数量有限的研究，并对所采用的框架以及所考虑的成本和结果范围过窄提出了批评。我们将这个新框架应用于英国为医院引入的首个P4P计划。我们强调，成本效益评估需要考虑谁是任何成本节约的剩余索取者、正外部性和负外部性的可能性，以及绩效改善是一种短期活动还是投资活动。我们对“提升质量”倡议的应用表明，激励性支付占1300万英镑总计划成本的不到一半。通过产生约5200个质量调整生命年以及因缩短住院时间节省440万英镑，我们发现该计划在其首个18个月内是对资源的一种具有成本效益的利用。
