Paying Doctors For Outcomes Makes Sense in Theory. So Why Doesn ’ t it Work in the Real World?

By STEPHEN SOUMERAI and ROSS KOPPEL For decades, the costs of health care in America have escalated without comparable improvements in quality. This is the central paradox of the American system, in which costs outstrip those everywhere else in the developed world, even though health outcomes are rarely better, and often worse. In an effort to introduce more powerful incentives for improving care, recent federal and private policies have turned to a “pay-for-performance” model: Physicians get bonuses for meeting certain “quality of care standards.” These can range from demonstrating that they have done procedures that ought to be part of a thorough physical (taking blood pressure) to producing a positive health outcome (a performance target like lower cholesterol, for instance). Economists argue that such financial incentives motivate physicians to improve their performance and increase their incomes. In theory, that should improve patient outcomes. But in practice, pay-for-performance simply doesn’t work. Even worse, the best evidence reveals that giving doctors extra cash to do what they are trained to do can backfire in ways that harm patients’ health. The stakes are high. Britain, with a much different health system — single payer — has embraced pay-for-performance in a big way, spending well over $12 billion on such programs in 12 years. And pay for performance is a feature of virtually every major health program in the US. While cost estimates are s...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Repeal Replace Uncategorized Source Type: blogs