Zaresani Arezou, Scott Anthony
University of Manitoba, Institute for Labor Studies (IZA) and Tax and Transfer Policy Institute (TTPI), 15 Chancellors Circle, Fletcher Argue Building, Winnipeg, Manitoba, Canada.
The University of Melbourne, Melbourne, Australia.
BMC Health Serv Res. 2021 Feb 24;21(1):175. doi: 10.1186/s12913-021-06118-8.
This study investigated if the evidence on the success of the Pay for Performance (P4P) schemes in healthcare is changing as the schemes continue to evolve by updating a previous systematic review.
A meta-regression analysis using 116 studies evaluating P4P schemes published between January 2010 to February 2018. The effects of the research design, incentive schemes, use of incentives, and the size of the payment to revenue ratio on the proportion of statically significant effects in each study were examined.
There was evidence of an increase in the range of countries adopting P4P schemes and weak evidence that the proportion of studies with statistically significant effects have increased. Factors hypothesized to influence the success of schemes have not changed. Studies evaluating P4P schemes which made payments for improvement over time, were associated with a lower proportion of statistically significant effects. There was weak evidence of a positive association between the incentives' size and the proportion of statistically significant effects.
The evidence on the effectiveness of P4P schemes is evolving slowly, with little evidence that lessons are being learned concerning the design and evaluation of P4P schemes.
本研究通过更新先前的系统评价，调查了随着绩效薪酬（P4P）计划在医疗保健领域不断发展，有关其成功的证据是否正在发生变化。
采用元回归分析，纳入了2010年1月至2018年2月间发表的116项评估P4P计划的研究。研究了研究设计、激励计划、激励措施的使用以及支付与收入比率的大小对每项研究中具有统计学显著效果的比例的影响。
有证据表明采用P4P计划的国家范围有所增加，且有微弱证据表明具有统计学显著效果的研究比例有所上升。假设影响计划成功的因素并未改变。评估随时间推移为改进而支付费用的P4P计划的研究，其具有统计学显著效果的比例较低。有微弱证据表明激励措施的规模与具有统计学显著效果的比例之间存在正相关。
关于P4P计划有效性的证据正在缓慢演变，几乎没有证据表明在P4P计划的设计和评估方面吸取了教训。
