Pay for performance is the idea that doctor be paid based on the quality of their work rather than how many tests they order, pills they prescribe, or the number of procedures performed. It is meant to help fix the overpriced and underperforming health care system.
The idea behind this is that if you reward quality health care you will receive quality health care. New York City plans to adopt a plan that gives hospitals bonuses to distribute to doctors based on patient satisfaction, moving cases through the system, and administering certain types of therapies. However there is a question as to whether pay for performance really works.
While pay for performance employs incentives, the bonuses are generally not large enough to change behavior. Additionally, the performance indictors do not always measure things that a doctor can control. Providers also learn how to manipulate the results by altering behavior in ways that indicate changes to get the bonuses while ignoring other factors that are not considered.
When it comes to lowering the cost of health care, pay for performance does not address one major problem in the United States which is that Americans, when compared to people in other developed countries, pay twice as much per capita on health care. The health care system in the United States charges more for each service, such as office visits, stays in hospital beds, and antibiotics than systems in other countries.
One alternative to pay for performance that has been suggested is to appeal to doctors’ professionalism. One doctor came up with a scheme that greatly reduced infections associated with catheters simply by disseminating to doctors and nurses simple operating room reminders such as washing hands or to wear a sterile mask.
This did not have any financial incentives. It simply appealed to professional pride. Another suggestion has been for the United States to create an agency that would compile and audit information about hospital performance and make it public. Any one or a combination of these possible solutions may help to lower the cost of health care.
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