EvidENT team, UCL Ear Institute, London.
Centre for Health Policy, Imperial College London, London.
Br J Gen Pract. 2017 Nov;67(664):e800-e815. doi: 10.3399/bjgp17X693149. Epub 2017 Oct 9.
Provider financial incentives are being increasingly adopted to help improve standards of care while promoting efficiency.
To review the UK evidence on whether provider financial incentives are an effective way of improving the quality of health care.
Systematic review of UK evidence, undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations.
MEDLINE and Embase databases were searched in August 2016. Original articles that assessed the relationship between UK provider financial incentives and a quantitative measure of quality of health care were included. Studies showing improvement for all measures of quality of care were defined as 'positive', those that were 'intermediate' showed improvement in some measures, and those classified as 'negative' showed a worsening of measures. Studies showing no effect were documented as such. Quality was assessed using the Downs and Black quality checklist.
Of the 232 published articles identified by the systematic search, 28 were included. Of these, nine reported positive effects of incentives on quality of care, 16 reported intermediate effects, two reported no effect, and one reported a negative effect. Quality assessment scores for included articles ranged from 15 to 19, out of a maximum of 22 points.
The effects of UK provider financial incentives on healthcare quality are unclear. Owing to this uncertainty and their significant costs, use of them may be counterproductive to their goal of improving healthcare quality and efficiency. UK policymakers should be cautious when implementing these incentives - if used, they should be subject to careful long-term monitoring and evaluation. Further research is needed to assess whether provider financial incentives represent a cost-effective intervention to improve the quality of care delivered in the UK.
为了帮助提高护理标准并提高效率，越来越多地采用了医疗服务提供者的财务激励措施。
综述英国有关提供者财务激励措施是否是改善医疗保健质量的有效方法的证据。
按照系统评价和荟萃分析（PRISMA）建议进行的英国证据的系统回顾。
2016 年 8 月在 MEDLINE 和 Embase 数据库中进行了搜索。纳入了评估英国提供者财务激励措施与医疗保健质量的定量衡量标准之间关系的原始文章。将所有护理质量措施都得到改善的研究定义为“阳性”，部分措施得到改善的研究定义为“中间”，而措施恶化的研究定义为“阴性”。将未显示效果的研究记录为“阴性”。使用唐斯和布莱克质量检查表评估质量。
系统搜索共确定了 232 篇已发表的文章，其中 28 篇被纳入。其中，有 9 项研究报告了激励措施对护理质量的积极影响，16 项研究报告了中间效果，2 项研究报告了无影响，1 项研究报告了负面效果。纳入文章的质量评估得分从 15 分到 19 分不等，满分为 22 分。
英国提供者财务激励措施对医疗保健质量的影响尚不清楚。由于这种不确定性及其高昂的成本，使用这些激励措施可能会适得其反，无法实现提高医疗保健质量和效率的目标。英国政策制定者在实施这些激励措施时应谨慎-如果使用，则应进行仔细的长期监测和评估。需要进一步研究，以评估提供者财务激励措施是否代表改善英国提供的护理质量的具有成本效益的干预措施。
