nordBLICK Augenklinik Bellevue, Lindenallee 21-23, 24105 Kiel, Germany.
Friedrich-Alexander-University Erlangen-Nuremberg, School of Business and Economics, Institute of Management (IFM), Lange Gasse 20, 90403 Nuremberg, Germany.
Health Policy. 2018 Jun;122(6):667-673. doi: 10.1016/j.healthpol.2018.03.013. Epub 2018 Mar 22.
Pay-for-performance (P4P) has become a popular approach to increase effectiveness and efficiency in healthcare. So far, there is little evidence regarding the potential of P4P in the German healthcare setting. The aim of this study was to determine the impact of P4P on the quality of care in cataract surgery.
In 2012, a P4P program was implemented in a German surgical centre for ophthalmology. Five quality measures regarding process quality, outcomes, and patient satisfaction were measured over a period of 4.5 years. The P4P scheme consisted of bonus and penalty payments accounting for five per cent of total compensation. Overall, 1657 P4P cases were examined and compared with 4307 control cases. Interrupted time series and group comparisons were conducted to identify quality and spill-over effects.
We found a positive impact on process quality and patient satisfaction before the implementation of the P4P scheme, but declining trends during and after the implementation. Our findings did not show an impact of P4P on outcome measures. Furthermore, P4P did not result in better quality of care, compared with the German hospital-based reimbursement scheme.
This study did not show any positive long-term effects of the implementation of P4P on quality of care. Therefore, our results do not support the hypothesis that P4P leads to significant improvements in quality of care.
绩效薪酬制（P4P）已成为提高医疗保健效果和效率的一种流行方法。迄今为止，关于 P4P 在德国医疗保健环境中的潜力的证据很少。本研究旨在确定 P4P 对白内障手术护理质量的影响。
2012 年，德国一家眼科外科中心实施了 P4P 计划。在 4.5 年的时间里，测量了 5 项关于流程质量、结果和患者满意度的质量指标。P4P 计划由占总薪酬 5%的奖金和罚款支付组成。总共检查了 1657 例 P4P 病例，并与 4307 例对照病例进行了比较。采用中断时间序列和组间比较来确定质量和溢出效应。
我们发现，在实施 P4P 计划之前，流程质量和患者满意度呈上升趋势，但在实施过程中和之后呈下降趋势。我们的研究结果表明，P4P 对结果指标没有影响。此外，与德国基于医院的报销计划相比，P4P 并没有带来更好的护理质量。
本研究未显示实施 P4P 对护理质量的任何长期积极影响。因此，我们的结果不支持 P4P 会导致护理质量显著改善的假设。
