Target payments in primary care: effects on professional practice and health care outcomes

摘要: BACKGROUND: The method by which physicians are paid may affect their professional practice. Although payment systems be used to achieve policy objectives (e.g. improving quality of care, cost containment and recruitment under-served areas), little is known about the effects different in achieving these objectives. Target payments a system remunerate professionals only if they provide minimum level care. OBJECTIVES: To evaluate impact target on practice primary care (PCPs) health outcomes. SEARCH STRATEGY: We searched Cochrane Effective Practice Organisation Care Group specialised register; Controlled Trials Register; MEDLINE (1966 October 1997); BIDS EMBASE (1980 ISI (1981 EconLit (1969 HealthStar (1975 1997) Helmis (1984 economics discussion paper series Universities York, Aberdeen, Sheffield, Bristol, Brunel, McMaster; Swedish Institute Health Economics; RAND corporation; reference lists articles. SELECTION CRITERIA: Randomised trials, controlled before after studies interrupted time analyses interventions comparing with alternative methods payment, patient outcomes, services utilisation, costs, equity PCP satisfaction working environment. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data assessed study quality. MAIN RESULTS: were included involving 149 practices. use remuneration PCPs was associated improvements immunisation rates, but increase statistically significant one two studies. REVIEWER'S CONCLUSIONS: evidence from identified this review not sufficient or power obtain clear answer question as whether provides Additional efforts should directed evaluating changes physicians' systems. it would difficult design randomised trial such systems, politically conduct trials.