Pay-for-performance for primary care physicians: a systematic review_Chinese Journal of Evidence-Based Medicine

Authors：

GAO Linhui ^1,2 , ZANG Sujie ³ , MENG Qingyue ⁴ , Anthony Scott ⁵ , YUAN Beibei ⁴ , ZHANG Lu ⁶ ,  JIA Liying ^1,2

1. Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, P.R.China;
2. NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan 250012, P.R.China;
3. The Second Hospital of Shandong University, Jinan 250033, P.R.China;
4. China Center for Health Development Studies (CCHDS), Peking University, Beijing 100191, P.R.China;
5. Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, Melbourne 3010, Australia;
6. Weihai Health Care Security Administration, Weihai 264500, P.R.China;

Corresponding author：

JIA Liying, Email: lyjia@sdu.edu.cn

Keywords：

Pay for performance; Payment; Primary care physician; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.202107170

Video：

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Objective To systematically review the efficacy of pay-for-performance (P4P) for primary care physicians (PCPs). Methods The Cochrane Library, Database of Abstracts of Reviews of Effects, EMbase, Web of Science, PubMed, Dissertations and Theses Database, EconLit, CNKI, WanFang Data, IDEAS, and POPLINE were searched to collect studies on the efficacy of P4P for PCPs from inception to May 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Statistical analysis was then performed by using RevMan 5.4 software. Results A total of 10 studies were included. The results of meta-analysis showed that P4P incentives possibly improved child immunization status (RR=1.27, 95%CI 1.19 to 1.36, P<0.001), slightly improved primary care physicians’ prescribing of guideline-recommended antihypertensive medicines compared with existing payment method (RR=1.07, 95%CI 1.02 to 1.12, P=0.006), and improved a mixed outcome measure of service provision and patient health outcomes (RR=1.13, 95%CI 1.04 to 1.23, P=0.004). Conclusions Current evidence shows that P4P possibly increases the quantity of health service provision and improve quality of service provision for targeted populations. The effects of P4P on health outcomes is uncertain. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.

Citation： GAO Linhui, ZANG Sujie, MENG Qingyue, Anthony Scott, YUAN Beibei, ZHANG Lu, JIA Liying. Pay-for-performance for primary care physicians: a systematic review. Chinese Journal of Evidence-Based Medicine, 2021, 21(11): 1308-1315. doi: 10.7507/1672-2531.202107170 Copy

1.	Jia L, Meng Q, Scott A, et al. Payment methods for healthcare providers working in outpatient healthcare settings. Cochrane Database Syst Rev, 2021, (1): CD011865.
2.	袁蓓蓓, 何莉, 孟庆跃, 等. 按绩效支付方式对门诊服务机构绩效的效果评价. 中国卫生政策研究, 2017, 10(9): 8-21.
3.	Cochrane Effective Practice and Organisation of Care (EPOC). What study designs can be considered for inclusion in an EPOC review and what should they be called? Available at: https://doi.org/10.5281/zenodo.5106085.
4.	Collins E, Katona C, Orrell M. Management of depression in the elderly by general practitioners: II. Attitudes to ageing and factors affecting practice. Fam Pract, 1995, 12(1): 12-17.
5.	Higgins JPT, Thomas J, Chandler J, et al. Cochrane handbook for systematic reviews of interventions (version 6.2) . Available at:https://training.cochrane.org/handbook.
6.	Cochrane Effective Practice and Organisation of Care (EPOC). Suggested risk of bias criteria for EPOC reviews. Available at:https://epoc.cochrane.org/sites/epoc.cochrane.org/files/public/uploads/Resources-for-authors2017/suggested_risk_of_bias_criteria_for_epoc_reviews.pdf.
7.	Fairbrother G, Hanson KL, Friedman S, et al. The impact of physician bonuses, enhanced fees, and feedback on childhood immunization coverage rates. Am J Public Health, 1999, 89(2): 171-175.
8.	Fairbrother G, Siegel MJ, Friedman S, et al. Impact of financial incentives on documented immunization rates in the inner city: results of a randomized controlled trial. Ambul Pediatr, 2001, 1(4): 206-212.
9.	Petersen LA, Simpson K, Pietz K, et al. Effects of individual physician-level and practice-level financial incentives on hypertension care: a randomized trial. JAMA, 2013, 310(10): 1042-1050.
10.	Chung S, Palaniappan L, Wong E, et al. Does the frequency of pay-for-performance payment matter. -Experience from a randomized trial. Health Serv Res, 2010, 45(2): 553-564.
11.	Gleeson S, Kelleher K, Gardner W. Evaluating a pay-for-performance program for medicaid children in an accountable care organization. JAMA Pediatr, 2016, 170(3): 259-266.
12.	Greene J. An examination of pay-for-performance in general practice in Australia. Health Serv Res, 2013, 48(4): 1415-1432.
13.	Lee TT, Cheng SH, Chen CC, et al. A pay-for-performance program for diabetes care in Taiwan: a preliminary assessment. Am J Manag Care, 2010, 16(1): 65-69.
14.	Li J, Hurley J, DeCicca P, et al. Physician response to pay-for-performance: evidence from a natural experiment. Health Econ, 2014, 23(8): 962-978.
15.	Young GJ, Meterko M, Beckman H, et al. Effects of paying physicians based on their relative performance for quality. J Gen Intern Med, 2007, 22(6): 872-876.
16.	Young GJ, Beckman H, Baker E. Financial incentives, professional values and performance: a study of pay-for-performance in a professional organization. J Organiz Behav, 2012, 33(7): 964-983.
17.	杜会征, 黑蕴红, 龙玉其. 北京市基本医疗保险支付方式改革的问题及对策. 临床医药实践, 2019, 28(7): 557-560.
18.	张馨元, 韩优莉, 薄云鹊, 等. 由后付制向预付制转变对医生行为影响的实验研究. 中国卫生经济, 2020, 39(4): 28-32.
19.	吴姝德. 基于绩效考核的全科医生团队薪酬激励机制研究. 武汉: 华中科技大学, 2016.
20.	朱晓丽, 代涛, 黄菊. 若干欧洲国家全科医生支付方式演变及启示. 医学与哲学, 2017, 38(7): 56-59.
21.	Scott A, Sivey P, Ait Ouakrim D, et al. The effect of financial incentives on the quality of health care provided by primary care physicians. Cochrane Database Syst Rev, 2011, (9): CD008451.
22.	Witter S, Fretheim A, Kessy FL, et al. Paying for performance to improve the delivery of health interventions in low- and middle-income countries. Cochrane Database Syst Rev, 2012, (2): CD007899.
23.	Flodgren G, Eccles MP, Shepperd S, et al. An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes. Cochrane Database Syst Rev, 2011, (7): CD009255.
24.	贾莉英, 袁蓓蓓, 王健, 等. 卫生政策系统评价方法探讨. 中国循证医学杂志, 2009, 9(10): 1037-1043.
25.	贾莉英. 卫生政策系统综述方法研制与实例研究. 济南: 山东大学, 2009.

1. Jia L, Meng Q, Scott A, et al. Payment methods for healthcare providers working in outpatient healthcare settings. Cochrane Database Syst Rev, 2021, (1): CD011865.
2. 袁蓓蓓, 何莉, 孟庆跃, 等. 按绩效支付方式对门诊服务机构绩效的效果评价. 中国卫生政策研究, 2017, 10(9): 8-21.
3. Cochrane Effective Practice and Organisation of Care (EPOC). What study designs can be considered for inclusion in an EPOC review and what should they be called? Available at: https://doi.org/10.5281/zenodo.5106085.
4. Collins E, Katona C, Orrell M. Management of depression in the elderly by general practitioners: II. Attitudes to ageing and factors affecting practice. Fam Pract, 1995, 12(1): 12-17.
5. Higgins JPT, Thomas J, Chandler J, et al. Cochrane handbook for systematic reviews of interventions (version 6.2) . Available at:https://training.cochrane.org/handbook.
6. Cochrane Effective Practice and Organisation of Care (EPOC). Suggested risk of bias criteria for EPOC reviews. Available at:https://epoc.cochrane.org/sites/epoc.cochrane.org/files/public/uploads/Resources-for-authors2017/suggested_risk_of_bias_criteria_for_epoc_reviews.pdf.
7. Fairbrother G, Hanson KL, Friedman S, et al. The impact of physician bonuses, enhanced fees, and feedback on childhood immunization coverage rates. Am J Public Health, 1999, 89(2): 171-175.
8. Fairbrother G, Siegel MJ, Friedman S, et al. Impact of financial incentives on documented immunization rates in the inner city: results of a randomized controlled trial. Ambul Pediatr, 2001, 1(4): 206-212.
9. Petersen LA, Simpson K, Pietz K, et al. Effects of individual physician-level and practice-level financial incentives on hypertension care: a randomized trial. JAMA, 2013, 310(10): 1042-1050.
10. Chung S, Palaniappan L, Wong E, et al. Does the frequency of pay-for-performance payment matter. -Experience from a randomized trial. Health Serv Res, 2010, 45(2): 553-564.
11. Gleeson S, Kelleher K, Gardner W. Evaluating a pay-for-performance program for medicaid children in an accountable care organization. JAMA Pediatr, 2016, 170(3): 259-266.
12. Greene J. An examination of pay-for-performance in general practice in Australia. Health Serv Res, 2013, 48(4): 1415-1432.
13. Lee TT, Cheng SH, Chen CC, et al. A pay-for-performance program for diabetes care in Taiwan: a preliminary assessment. Am J Manag Care, 2010, 16(1): 65-69.
14. Li J, Hurley J, DeCicca P, et al. Physician response to pay-for-performance: evidence from a natural experiment. Health Econ, 2014, 23(8): 962-978.
15. Young GJ, Meterko M, Beckman H, et al. Effects of paying physicians based on their relative performance for quality. J Gen Intern Med, 2007, 22(6): 872-876.
16. Young GJ, Beckman H, Baker E. Financial incentives, professional values and performance: a study of pay-for-performance in a professional organization. J Organiz Behav, 2012, 33(7): 964-983.
17. 杜会征, 黑蕴红, 龙玉其. 北京市基本医疗保险支付方式改革的问题及对策. 临床医药实践, 2019, 28(7): 557-560.
18. 张馨元, 韩优莉, 薄云鹊, 等. 由后付制向预付制转变对医生行为影响的实验研究. 中国卫生经济, 2020, 39(4): 28-32.
19. 吴姝德. 基于绩效考核的全科医生团队薪酬激励机制研究. 武汉: 华中科技大学, 2016.
20. 朱晓丽, 代涛, 黄菊. 若干欧洲国家全科医生支付方式演变及启示. 医学与哲学, 2017, 38(7): 56-59.
21. Scott A, Sivey P, Ait Ouakrim D, et al. The effect of financial incentives on the quality of health care provided by primary care physicians. Cochrane Database Syst Rev, 2011, (9): CD008451.
22. Witter S, Fretheim A, Kessy FL, et al. Paying for performance to improve the delivery of health interventions in low- and middle-income countries. Cochrane Database Syst Rev, 2012, (2): CD007899.
23. Flodgren G, Eccles MP, Shepperd S, et al. An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes. Cochrane Database Syst Rev, 2011, (7): CD009255.
24. 贾莉英, 袁蓓蓓, 王健, 等. 卫生政策系统评价方法探讨. 中国循证医学杂志, 2009, 9(10): 1037-1043.
25. 贾莉英. 卫生政策系统综述方法研制与实例研究. 济南: 山东大学, 2009.

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