Does performance-related pay work in healthcare?
A new study, led by a collaboration of academics, including Professor Winnie Yip from the Blavatnik School of Government, examines the effects of pay-for-performance, combined with capitation, in China’s largely rural Ningxia Province. The study is published today in the journal Health Affairs.
Pay-for-performance—reimbursing healthcare providers based on the results they achieved with their patients as a way to improve quality and efficiency—has become a major component of health reforms in the United States, the United Kingdom, and other affluent countries. Although the approach has also become popular in the developing world, there has been little evaluation of its impact.
Between 2009 and 2012, the authors, in collaboration with the provincial government, conducted a matched-pair, cluster-randomized experiment to review that province’s primary care providers’ antibiotic prescribing practices, health spending, and several other factors. They found a near-15 percent reduction in antibiotic prescriptions and a small decline in total spending per visit to community clinics.
The authors noted that the success of this experiment has motivated the government of Ningxia Province to expand this intervention to the entire province. “From a policy perspective, our study offers several additional valuable lessons,” they conclude. “Provider patterns of overprescribing and inappropriate prescribing cannot be changed overnight; nor can patient demand, for which antibiotics are synonymous with quality care. Provider payment reform probably needs to be accompanied by training for providers and health education for patients.”
Link to Prof Winnie Yip biography
