Would German physicians opt for pay-for-performance programs? A willingness-to-accept experiment in a large general practitioners' sample

Is Economic Evaluation and Care Commissioning Focused on Achieving the Same Outcomes? Resource-Allocation Considerations and Challenges Using England as a Case Study

Commissioning describes the process of contracting appropriate care services to address pre-identified needs through pre-agreed payment structures. Outcomes-based commissioning (i.e., paying services for pre-agreed outcomes) shares a common goal with economic evaluation: achieving value for money for relevant outcomes (e.g., health) achieved from a finite budget. We describe considerations and challenges as to the practical role of relevant outcomes for evaluation and commissioning, seeking to bridge a gap between economic evaluation evidence and care commissioning. We describe conceptual (e.g., what are 'relevant' outcomes) alongside practical considerations (e.g., quantifying and using relevant endpoint or surrogate outcomes) and pertinent issues when linking outcomes to commissioning-based payment mechanisms, using England as a case study. Economic evaluation often focuses on a single endpoint health-focused maximand, e.g., quality-adjusted life-years (QALYs), whereas commissioning often focuses on activity-based surrogate outcomes (e.g., health monitoring), as easier-to-measure key performance indicators that are more acceptable (e.g., by clinicians) and amenable to being linked with payment structures. However, payments linked to endpoint and/or surrogate outcomes can lead to market inefficiencies; for example, when surrogates do not have the intended causal effect on endpoint outcomes or when service activity focuses on only people who can achieve prespecified payment-linked outcomes. Accounting for and explaining direct links from commissioners' payment structures to surrogate and then endpoint economic outcomes is a vital step to bridging a gap between economic evaluation approaches and commissioning. Decision-analytic models could aid this but they must be designed to account for relevant surrogate and endpoint outcomes, the payments assigned to such outcomes, and their interaction with the system commissioners purport to influence.

German physicians' expectations of healthcare management companies: An exploratory study

Background and aims

Even 20 years after the introduction of managed care (MC) in Germany, many physicians are skeptical of the concept, hindering its acceptance.

Methods

Based on multivariate statistical methods this exploratory study examines how so-called management companies, that is, administrative service providers within MC contracts, can increase physicians' acceptance of MC by offering, for example, day-to-day coordination and administrative tasks.

Results

As a main empirical result, we find support for this hypothesis, that is, that certain physicians evaluate their MC participation according to its prospective administrative support. Based on this, up to four clusters of physicians can be statistically identified in terms of their preferences regarding MC.

Conclusion

As a policy recommendation, we derive from our results that a future focus on the administrative support components of MC is essential to attract certain physician groups to participate in MC.

Pay for performance system in Turkey and the world; a global overview

Objective: This study aimed to compare the pay for performance system applied nationally in Turkey and in other countries around the world and to reveal the effects of the system applied in our country on the general surgery.

Material and Methods: Current literature and countries’ programs on the implementation of the pay for performance system were recorded. The results of the Turkish Surgical Association’s performance and Healthcare Implementation Communique (HIC) commission studies were evaluated in light of the literature.

Results: Many countries have implemented performance systems on a limited scale to improve quality, speed up the diagnosis, treatment, and control of certain diseases, and they have generally applied it as a financial promotion by receiving the support of health insurance companies and nongovernmental organizations. It turns out that surgeons in our country feel that they are being wronged because of the injustice in the current system because the property of their works is not appreciated and they cannot get the reward for the work they do. This is also the reason for the reluctance of medical school graduates to choose general surgery.

Conclusion: Authorities should pay attention to the opinions of associations and experts in the related field when creating lists of interventional procedures related to surgery. Equal pay should be given to equal work nationally, and surgeons should be encouraged by incentives to perform detailed, qualified surgeries. There is a possibility that the staff positions opened for general surgery, as well as, all surgical branches will remain empty in the near future.

Why do German physicians reject managed care?

BACKGROUND

Approximately 20 years after the launch of managed care (MC) in Germany, the initial dynamics have turned into an MC backlash with a poor image for MC among physicians and the insured. Factors in MC contract rejection by physicians have not previously been studied systematically.

OBJECTIVE

The objective of the study is to show that observed physician characteristics explain MC contract rejection in a quantitative model. These econometric findings will be related to suitable political measures to foster physicians' MC acceptance.

METHODS

Results are based on 500 completed responses to a survey among practicing physicians in Northern Germany. Physician cooperation, attitudes toward MC, and practice characteristics are addressed. A Heckman approach accounts for potential preselection of physicians by insurers. Econometric findings are complemented by a qualitative analysis of free-text answers.

RESULTS

Private patient share, physician age, and number of physicians per practice significantly increase rejection probability, whereas it is decreased by rural location. Qualitatively, administrative burden and loss of professional autonomy are the main reasons for MC refusal.

CONCLUSION

Current health policy focuses on institutional measures such as innovation funding to promote MC. Our results show that it may be more effective to turn attention to practicing physicians' preferences as a bottleneck to MC development.

The influence of welfare systems on pay-for-performance programs for general practitioners: A critical review

While pay-for-performance (P4P) programs are increasingly common tools used to foster quality and efficiency in primary care, the evidence concerning their effectiveness is at best mixed. In this article, we explore the influence of welfare systems on four P4P-related dimensions: the level of healthcare funders' commitment to P4Ps (by funding and length of program operation), program design (specifically target-based vs. participation-based program), physicians' acceptance of the program and program effects. Using Esping-Andersen's typology, we examine P4P for general practitioners (GPs) in thirteen European and North American countries and find that welfare systems contribute to explain variations in P4P experiences. Overall, liberal systems exhibited the most enthusiastic adoption of P4P, with significant physician acceptance, generous incentives and positive but modest program effects. Social democratic countries showed minimal interest in P4P for GPs, with the exception of Sweden. Although corporatist systems adopted performance pay, these countries experienced mixed results, with strong physician opposition. In response to this opposition, health care funders tended to favour participation-based over target-based P4P. We demonstrate how the interaction of decommodification and social stratification in each welfare regime influences these countries' experiences with P4P for GPs, directly for funders' commitment, program design and physicians' acceptance, and indirectly for program effects, hence providing a framework for analyzing P4P in other contexts or care settings.