Making sense of paying for performance in health care: short-term targets versus patient-relevant outcomes
Stephen Jan
The George Institute for Global Health, UNSW Sydney, 1 King Street, Newtown, NSW 2042, Australia. Email: sjan@georgeinstitute.org
Australian Health Review 43(5) 500-501 https://doi.org/10.1071/AH18178
Submitted: 26 March 2018 Accepted: 24 November 2018 Published: 27 February 2019
Journal Compilation © AHHA 2019 Open Access CC BY-NC-ND
Abstract
Although there has been growing interest in pay-for-performance programs in health, the evidence of their success is weak. Reasons that have been posited for this are that they are misdirected (i.e. individual providers are not directly linked to incentives targeted at a practice level) or that they are too weak, either because of cost considerations or that they have been dominated by strong social or professional norms. In practice, a problem of pay-for-performance programs is that they are based on a transactional view of health care focused on short-term targets (such as vaccination rates, blood pressure control and screening rates). In designing pay-for-performance programs, health care needs to be seen as relational, which means rewarding on the basis of longer-term goals that may be more meaningful to patients, such as control of overall cardiovascular risk, quality of life, continuity of care and prevention of unplanned hospitalisations.
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