Eero Merilind
Background: Many countries are using financial incentive schemes to improve quality in family practices. There is a need for studies with strong research designs to determine the effects, both positive and negative, of payment for performance (P4P) in healthcare. The aim of this study was to find out the impact of P4P on number of family doctors (FD) visits, specialist consultations and hospital bed occupancy.
Methods: This longitudinal study was conducted using the database from the Estonian Health Insurance Fund. All working FDs (N=803) were divided into two groups: "good" and "poor" outcome groups according their achievements in P4P. The study group (N=80) consisted patients of the 40 FDs who had a good outcome in the P4P system (N=26,327) and patients of the 40 FDs with a poor outcome (N=19,865). We observed these two study groups in the monitoring of two chronic diseases (hypertension and diabetes mellitus type 2), to find out the impact of P4P on FDs visits, outpatient specialist consultations and hospital bed occupancy.
Results: During the observation period (2014), we found that, the P4P system had an impact on FDs visits, outpatient specialist consultations and hospital bed occupancy. The study group with a good outcome had increased numbers of FDs visits in hypertension (all stages) and diabetes mellitus type 2, as well as an increased rate of specialist consultations in hypertension, reduced hospital bed occupancy both, by hypertension and diabetes mellitus type 2, compared to poor outcome FDs.
Conclusion: A good outcome in P4P increases the workload for FDs and for specialists. Although hospital bed occupancy was somewhat reduced, we could not see the clear positive effects of P4P on the other indicators.
