Financial incentives can improve care but can also have unintended consequences.Aligning financial incentives with good clinical practice has the potential to improve quality of care. Researchers systematically reviewed the literature to find controlled studies that assessed the effect of explicit financial incentives on quantitative measures of health care quality.
Of nine studies of provider-group incentives, two found small improvements in quality measures and five found partial effects (e.g., an improvement in cervical cancer screening, but not in mammography). One study of a payment-system incentive found an increase in nursing home admissions for patients who needed that level of care (the intended effect). However, in that study and one other study of a payment-system incentive, there were unintended negative effects of incentives, such as avoidance of severely ill patients, or a tendency to claim that patients were severely ill and then to report short recovery periods. In six studies of physician-level incentives, five found positive or partial effects. But in two studies (one of a physician incentive to provide vaccinations and one of a provider-group incentive to provide smoking cessation advice), there were improvements in documentation but not in actual provision of these services.
Of nine studies of provider-group incentives, two found small improvements in quality measures and five found partial effects (e.g., an improvement in cervical cancer screening, but not in mammography). One study of a payment-system incentive found an increase in nursing home admissions for patients who needed that level of care (the intended effect). However, in that study and one other study of a payment-system incentive, there were unintended negative effects of incentives, such as avoidance of severely ill patients, or a tendency to claim that patients were severely ill and then to report short recovery periods. In six studies of physician-level incentives, five found positive or partial effects. But in two studies (one of a physician incentive to provide vaccinations and one of a provider-group incentive to provide smoking cessation advice), there were improvements in documentation but not in actual provision of these services.
Comment:
Because of the small number and limited scope of the studies identified, the authors suggest that generalize ability of the findings is limited. Nonetheless, financial incentives apparently can have positive effects on quality of care. But carefully designed incentives and further study are clearly needed to achieve these improvements while avoiding unintended negative effects.
-Richard Saitz, MD, MPH, FACP, FASAM
Because of the small number and limited scope of the studies identified, the authors suggest that generalize ability of the findings is limited. Nonetheless, financial incentives apparently can have positive effects on quality of care. But carefully designed incentives and further study are clearly needed to achieve these improvements while avoiding unintended negative effects.
-Richard Saitz, MD, MPH, FACP, FASAM
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