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When it comes to healthcare, does paying for performance always pay off?

As Australia’s health policymakers show increasing interest in expanding the practice of ‘pay for performance’ in health programs, leading medical experts and health economists will present an open forum on the pros and cons of financial incentives at Bond University on March 10.

“Pay for performance programs are generally seen by healthcare policymakers as a means of promoting prevention strategies,” said forum convenor and one of the world’s leading experts in Evidence-Based Medicine, Professor Paul Glasziou.

“In various Australian states, Practice Incentive Payments (PIPs) and Service Incentive Payments (SIPs) are paid to doctors, clinicians and hospitals for meeting certain targets in the delivery of preventative practices such as childhood immunisations, diabetes monitoring programs, pap tests and so on.

“In the United Kingdom and the USA, the practice is far more widespread and Australian policymakers are currently looking very closely at the potential for following in their footsteps.

“As such, we believe it is timely to bring the key authorities together with the medical community for a frank and public discussion of the pros and cons.”

According to Dr Glasziou, the Pay for Performance (P4P) experience both here and overseas has not been all good news.

“There has been evidence that these financial incentives can misdirect the clinician’s attention away from the patient issues at hand; that clinicians become de-motivated and feel they have lost control of patient care by being “told what to do”; and that it encourages game playing that masks the true picture – for instance, when patients are transferred from one hospital to another in order to meet discharge targets.”

The aim of the March 10 Financial Incentives Conference at Bond University is to ensure that P4P programs are balanced against any potential downsides and that both policymakers and clinicians understand when and where such programs can do more harm than good.

“Pay for Performance is not a one-size-fits-all approach,” said Dr Glasziou.

“Getting the right type of incentive to the right person in the right circumstances is crucial to implementation.

“In presenting an overview of the evidence for and against financial incentives, our aim is to develop a checklist that will aid decision-makers in when and how they can be used for optimum effect,” he said.

Conference presenters include leading health economics researcher, Professor Tony Scott and Dr Ian Scott who will present the findings of the recent P4P experiment conducted in Queensland hospitals; general practitioner and economist, Dr Jenny Doust, who has conducted extensive research into the adverse impacts of P4P; and healthcare policy advisor, Dr Heather Buchan.

The conference is open to all healthcare providers across the broad spectrum of the industry and to interested members of the general public.

Register here or for more information contact the Centre for Research in Evidence-Based Practice at Bond University on 07-5595 4482.

Background

In the global healthcare industry, ‘pay for performance’ or P4P refers to financial incentives paid to healthcare providers for meeting specified targets – increasing the number of vaccinations administered to patients in a general practice setting, for instance; or discharging hospital patients within a certain timeframe.

The P4P practice has been widely adopted in the United Kingdom where over one billion pounds in financial incentives are paid out every year. The practice is also becoming increasingly common in the United States.

Whilst the practice is not as widespread in Australia, a number of Practice Incentive Payments and Service Incentive Payments have been operating for many years and Queensland Health has recently conducted an experiment within the state’s hospital system to test the waters for expanding the program.
 

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