Impact of pay for performance on behavior of primary care physicians and patient outcomes

This paper measures the extent to which medical groups experience external pay-for-performance incentives based on quality and patient satisfaction and the extent to which these groups pay their primary care and specialist physicians using similar criteria. Over half (52%) of large medical groups received bonus payments from health insurance plans in the period 2006–2007 based on measures of quality and patient satisfaction. Medical groups facing external pay-for-performance incentives are more likely to pay their primary care physicians (odds ratio [OR] 4.5; p<.001) and specialists (OR 2.5; p=.07) based on quality and satisfaction. Groups facing capitation payment incentives to control costs are more likely to pay member physicians on salary and less likely to pay based on productivity (p<.001 for primary care; p<.05 for specialists) than groups paid by insurers on a fee-for-service basis.

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Systematic review protocol examining the effects of introducing pay-for-performance for primary care physicians on diabetes outcomes in single-payer healthcare systems (Preprint)

10.2196/preprints.11154 ◽

2018 ◽

Author(s):

Neeru Gupta

Keyword(s):

Systematic Review ◽

Primary Care ◽

Diabetes Care ◽

Primary Care Physicians ◽

Pay For Performance ◽

Unintended Consequences ◽

Research Database ◽

Diabetes Outcomes ◽

Single Payer ◽

Wide Range

BACKGROUND Although pay-for-performance (P4P) for diabetes care is increasingly common across health organizations, evidence of its effectiveness in improving population health and service delivery is deficient. This information gap is attributable in part to the heterogeneity of healthcare financing, covered medical conditions, care settings, and provider remuneration arrangements within and across countries. OBJECTIVE This paper outlines a protocol for a systematic review examining the effects of introducing P4P for physicians in primary care and community settings to support guideline-based diabetes care. Our aim is to reduce the heterogeneity of evidence presented that has deterred conclusiveness of previous reviews by narrowing the focus to disease-specific P4P schemes in single-payer healthcare insurance systems. This approach enables us to minimize the risk of unintended consequences of P4P such as physicians’ gaming the payment system. METHODS Our review systematically searches, appraises, and synthesizes the literature concentrating on whether P4P for primary care physicians leads to better diabetes outcomes in single-payer health systems. We search 10 electronic databases and manually scan the reference lists of review articles and other global health literature. We include primary studies evaluating the effects of introducing P4P for diabetes care among primary care physicians in countries of universal health coverage. Outcomes of interest include patient morbidity, avoidable hospitalization, premature death, and healthcare costs. RESULTS We have received funding from Diabetes Canada and the New Brunswick Health Research Foundation to conduct policy-actionable diabetes health services research. Database searches were conducted and full-texts screened by two reviewers in 2017. We aim to submit the review for publication in 2018. CONCLUSIONS We are narratively synthesizing the data. Because of the wide range of outcomes considered, we do not expect to perform a meta-analysis. Since database searches were completed prior to the publication of this protocol, it is ineligible for registration with PROSPERO.

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Does a pay-for-performance program for primary care physicians alleviate health inequity in childhood vaccination rates?

International Journal for Equity in Health ◽

10.1186/s12939-015-0231-6 ◽

2015 ◽

Vol 14 (1) ◽

Cited By ~ 2

Author(s):

Alan Katz ◽

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Jennifer Emily Enns ◽

Dan Chateau ◽

Lisa Lix ◽

...

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Pay For Performance ◽

Health Inequity ◽

Childhood Vaccination ◽

Vaccination Rates

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The impact of physician empathy on patient outcomes: A gender analysis

British Journal of General Practice ◽

10.3399/bjgp.2021.0193 ◽

2021 ◽

pp. BJGP.2021.0193

Author(s):

Caroline Surchat ◽

Valérie Carrard ◽

Jacques Gaume ◽

Alexandre Berney ◽

Carole Clair

Keyword(s):

Primary Care ◽

Patient Outcomes ◽

Primary Care Physicians ◽

Cost Effective ◽

Relational Quality ◽

Observational Measures ◽

Fundamental Frequencies ◽

Patient Reported ◽

French Speaking ◽

The Impact

Background: Empathy in primary care settings has been linked to improved health outcomes. However, the operationalisation of empathy differs between studies, and no study concurrently compared affective, cognitive, and behavioural components of empathy regarding patient outcomes. Moreover, it is unclear how gender interacts with the studied dimensions. Aim: To examine the relationship between several empathy dimensions and patient-reported satisfaction, consultation’s quality and trust in physician, and to determine whether this relationship is moderated by physician’s gender. Design and setting: Analysis of 61 primary care physicians’ empathy in relation to 244 patient experience questionnaires in French-speaking part of Switzerland. Method: Sixty-one physicians were videotaped with two male and two female patients. Six different empathy measures were assessed: two self-reported measures, a facial recognition test, two external observational measures, and a Synchrony of Vocal Mean Fundamental Frequencies (SVMFF), measuring vocally coded arousal. After the consultation, patients indicated their satisfaction, trust, and quality of the consultation. Results: Female physicians self-rated their empathic concern above their male counterparts, whereas male physicians were more synchronised to their patients. SVMFF was the only significant predictor of all patient outcomes. Verbal empathy statements were linked to higher satisfaction when the physician was a man. Conclusion: Gender differences were observed more often in self-reported measures of empathy than in external measures, indicating a probable social desirability bias. SVMFF significantly predicted all patient outcomes and could be used as a cost-effective proxy of relational quality.

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