Markovitz Adam A, Ryan Andrew M
1 University of Michigan, Ann Arbor, MI, USA.
Med Care Res Rev. 2017 Feb;74(1):3-78. doi: 10.1177/1077558715619282. Epub 2016 Aug 3.
Research on the effects of pay-for-performance (P4P) in health care indicates largely disappointing results. This central finding, however, may mask important heterogeneity in the effects of P4P. We conducted a literature review to assess whether hospital and physician performance in P4P vary by patient and catchment area factors, organizational and structural capabilities, and P4P program characteristics. Several findings emerged: organizational size, practice type, teaching status, and physician age and gender modify performance in P4P. For physician practices and hospitals, a higher proportion of poor and minority patients is consistently associated with worse performance. Other theoretically influential characteristics-including information technology and staffing levels-yield mixed results. Inconsistent and contradictory effects of bonus likelihood, bonus size, and marginal costs on performance in P4P suggest organizations have not responded strategically to financial incentives. We conclude that extant heterogeneity in the effects of P4P does not fundamentally alter current assessments about its effectiveness.
对医疗保健领域绩效工资（P4P）效果的研究表明，结果大多令人失望。然而，这一核心发现可能掩盖了P4P效果方面的重要异质性。我们进行了一项文献综述，以评估P4P中医院和医生的绩效是否因患者和集水区因素、组织和结构能力以及P4P项目特征而有所不同。出现了几个发现：组织规模、执业类型、教学状况以及医生年龄和性别会改变P4P中的绩效。对于医生执业机构和医院而言，贫困和少数族裔患者比例较高始终与较差的绩效相关。其他理论上有影响的特征——包括信息技术和人员配备水平——产生了混合结果。奖金可能性、奖金规模和边际成本对P4P绩效的不一致和矛盾影响表明，各组织并未对财务激励措施做出战略性回应。我们得出结论，P4P效果中存在的现有异质性并未从根本上改变当前对其有效性的评估。
