Integrated Healthcare Association and P4P

The largest P4P program is run by California’s Integrated Healthcare Associates (IHA). A 2006 report (“Advancing quality through collaboration“) chronicles IHA’s progress in working with the California Association of Physician Groups as well as Dr. Stephen Shortell to establish a P4P measures. The report has two very interesting summary tables: one describes how the IHA…

The other P4P

The concept of pay-for-performance has been discussed repeatedly in this blog. But what about the other P4P: pay-for-participation? In the pay for participation model, payers compensate physicians to add infrastructure or partake in data collection. For instance, a health plan may pay providers to implement an electronic medical records system. Providers may also compensate physicians…

Empirical Findings on P4P

Pay-for-performance (P4P) is one of the latest hot topics in the health policy world. Yet it has not been conclusively answered whether or not P4P incentives affect the quality of care given. Meredith Rosenthal and Richard Frank review some of the more compelling empirical studies in their April 2006 paper in Medical Care Research &…

Physicians vs. Statisticians

An interesting post by Arnold Kling (“Doctors, Pharmaceuticals, and Statisticians“) reports on a randomized clinical trial which demonstrated that on average, angioplasties have no incremental health benefits once the patient is placed on multiple medications such as beta-blockers, ACE inhibitors, statins and blood thinners. Dr. Kling writes: “Doctors think that they add value by giving…

Do financial incentives affect the type of breast cancer surgery a patient receives?

There are two treatment options for patients with breast cancer.  The first is a breast conserving surgery (BCS) which removes the cancerous lump (lumpectomy) followed by irradiation treatment.  The second option is a mastectomy which removes the entire breast.  Lecia Apantaku claims in the American Family Physician journal in 2002, that “survival rates following breast conservation…

The effect of financial incentives on gatekeeping doctors

In 1991 in the UK, the British began allowing general practitioners (GPs) to participate in a fundholding scheme. The fundholding program would reimburse GPs if the amount of chargeable elective secondary care procedures was below their budget and financially penalize the GPs if the amount of secondary care which their patients received exceeded their budget.…

Those annoying HMO patients…

Why do HMO patients receive less care than fee-for-service patients?  Could it be that HMO patients are healthier (adverse selection) or that FFS compensation leads to increased demand for medical services (moral hazard)?  A paper by Shen, et al. (2004) finds that one reason could be that physician compensation could affect a doctor’s desire to perform…