Health Care Manage Rev. 2023;48(3):249-259. doi: 10.1097/HMR.0000000000000372. Epub 2023 May 12.
Performance-based budgeting (PBB) is a variation of pay for performance that has been used in government hospitals but could be applicable to any integrated system. It works by increasing or decreasing funding based on preestablished performance thresholds, which incentivizes organizations to improve performance. In late 2006, the U.S. Army implemented a PBB program that tied hospital-level funding decisions to performance on key cost and quality-related metrics.
The aim of this study was to estimate the impact of PBB on quality improvement in U.S. Army health care facilities.
This study used a retrospective difference-in-differences analysis of data from two Defense Health Agency data repositories. The merged data set encompassed administrative, demographic, and performance information about 428 military health care facilities. Facility-level performance data on quality indicators were compared between 187 Army PBB facilities and a comparison group of 241 non-PBB Navy and Air Force facilities before and after program implementation.
The Army's PBB programs had a positive impact on quality performance. Relative to comparison facilities, facilities that participated in PBB programs increased performance for over half of the indicators under investigation. Furthermore, performance was either sustained or continued to improve over 5 years for five of the six performance indicators examined long term.
Study findings indicate that PBB may be an effective policy mechanism for improving facility-level performance on quality indicators.
This study adds to the extant literature on pay for performance by examining the specific case of PBB. It demonstrates that quality performance can be influenced internally through centralized budgeting processes. Though specific to military hospitals, the findings might have applicability to other public and private sector hospitals who wish to incentivize performance internally in their organizational subunits through centralized budgeting processes.
绩效预算（PBB）是一种基于绩效的薪酬变体，已在政府医院中使用，但也可适用于任何综合系统。它通过根据预先设定的绩效阈值增加或减少资金来运作，从而激励组织提高绩效。2006 年末，美国陆军实施了一项 PBB 计划，该计划将医院层面的资金决策与关键成本和质量相关指标的绩效挂钩。
本研究旨在评估 PBB 对美国陆军医疗保健设施质量改进的影响。
本研究使用了来自两个国防卫生署（Defense Health Agency）数据存储库的数据回顾性差异差异分析。合并数据集涵盖了 428 个军事医疗保健设施的管理、人口统计和绩效信息。在计划实施前后，将 187 个陆军 PBB 设施与一个比较组的 241 个非 PBB 海军和空军设施的质量指标设施绩效数据进行了比较。
陆军的 PBB 计划对质量绩效产生了积极影响。与比较设施相比，参与 PBB 计划的设施提高了所调查的一半以上指标的绩效。此外，在所研究的六个绩效指标中的五个中，有五个在五年内持续或继续提高。
研究结果表明，PBB 可能是提高设施层面质量指标绩效的有效政策机制。
本研究通过考察 PBB 的具体案例，为基于绩效的薪酬的现有文献做出了贡献。它表明，可以通过集中的预算编制流程从内部影响质量绩效。虽然具体针对军事医院，但这些发现可能适用于其他希望通过集中预算编制流程在其组织单位内部激励绩效的公共和私营部门医院。
