Gillam Stephen
Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK.
J Healthc Leadersh. 2015 Sep 8;7:75-80. doi: 10.2147/JHL.S64365. eCollection 2015.
Pay-for-performance (P4P) schemes have become increasingly common in primary care, and this article reviews their impact. It is based primarily on existing systematic reviews. The evidence suggests that P4P schemes can change health professionals' behavior and improve recorded disease management of those clinical processes that are incentivized. P4P may narrow inequalities in performance comparing deprived with nondeprived areas. However, such schemes have unintended consequences. Whether P4P improves the patient experience, the outcomes of care or population health is less clear. These practical uncertainties mirror the ethical concerns of many clinicians that a reductionist approach to managing markers of chronic disease runs counter to the humanitarian values of family practice. The variation in P4P schemes between countries reflects different historical and organizational contexts. With so much uncertainty regarding the effects of P4P, policy makers are well advised to proceed carefully with the implementation of such schemes until and unless clearer evidence for their cost-benefit emerges.
绩效薪酬（P4P）计划在初级医疗保健中已变得越来越普遍，本文回顾了它们的影响。它主要基于现有的系统评价。证据表明，P4P计划可以改变卫生专业人员的行为，并改善那些受到激励的临床过程中记录的疾病管理。与非贫困地区相比，P4P可能会缩小贫困地区在绩效方面的不平等。然而，此类计划也有意外后果。P4P是否能改善患者体验、护理结果或人群健康尚不清楚。这些实际的不确定性反映了许多临床医生的伦理担忧，即采用简化方法管理慢性病指标与家庭医疗的人道主义价值观背道而驰。各国之间P4P计划的差异反映了不同的历史和组织背景。鉴于P4P效果存在如此多的不确定性，建议政策制定者在有更明确的成本效益证据之前，谨慎推进此类计划的实施。
