Does the implementation of pay-for-performance indicators improve the quality of healthcare? First results in France
BackgroundPay-for-performance (P4P) models are intended to promote quality of care in both hospitals and primary care settings. They are considered as a means of changing medical practices, particularly in primary care.ObjectivesThe first objective of this study was to assess how performance indicat...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-03-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1063806/full |
| _version_ | 1811157785321144320 |
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| author | Marc-Antoine Sanchez Marc-Antoine Sanchez Stéphane Sanchez Stéphane Sanchez Leila Bouazzi Louise Peillard Aline Ohl-Hurtaud Catherine Quantin Catherine Quantin |
| author_facet | Marc-Antoine Sanchez Marc-Antoine Sanchez Stéphane Sanchez Stéphane Sanchez Leila Bouazzi Louise Peillard Aline Ohl-Hurtaud Catherine Quantin Catherine Quantin |
| author_sort | Marc-Antoine Sanchez |
| collection | DOAJ |
| description | BackgroundPay-for-performance (P4P) models are intended to promote quality of care in both hospitals and primary care settings. They are considered as a means of changing medical practices, particularly in primary care.ObjectivesThe first objective of this study was to assess how performance indicators changed over time, measured through “Remuneration on Public Health Objectives” (ROSP) scores, between 2017 and 2020 in a large French region (Grand Est region), and to compare this evolution in the rural vs. urban areas of the region. The second objective was to focus on the area with the least improvement in ROSP scores and to investigate whether the scores and the available sociodemographic characteristics of the area were associated.MethodsFirst, we measured the evolution over time of P4P indicators (i.e., ROSP scores) obtained from the regional health insurance system, for GP practices in the Grand Est region between 2017 and 2020. We then compared the scores between the Aube Department and the rest of the region (urban areas). To address the second objective, we focused on the area found to have the least improvement in indicators to investigate whether there was a relationship between ROSP score and sociodemographic characteristics.ResultsMore than 40,000 scores were collected. We observed an overall improvement in scores over the study period. The urban area (Grand Est region minus the Aube) scored better than the rural area (Aube) for chronic disease management [median 0.91 (0.84–0.95) vs. 0.90(0.79–0.94), p < 0.001] and prevention [median 0.36 (0.22–0.45) vs. 0.33 (0.17–0.43), p < 0.001], but not for efficiency, where the rural area (Aube) performed better [median 0.67(0.56–0.74) vs. 0.69 (0.57–0.75 in the rest of the Grand Est region, p = 0.004]. In the rural area, we found no significant association between ROSP scores and sociodemographic characteristics, except for extreme rurality in some sub-areas.ConclusionsAt the regional level, the overall improvement in scores observed between 2017 and 2020 suggests that the implementation of ROSP indicators have improved the quality of care, particularly in urban areas. These results also suggest that efforts should be focused on rural areas, which already had the lowest scores at the start of the P4P program. |
| first_indexed | 2024-04-10T05:13:15Z |
| format | Article |
| id | doaj.art-ef47d1ca1a7b4999b4c412a63c9bd34f |
| institution | Directory Open Access Journal |
| issn | 2296-2565 |
| language | English |
| last_indexed | 2024-04-10T05:13:15Z |
| publishDate | 2023-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Public Health |
| spelling | doaj.art-ef47d1ca1a7b4999b4c412a63c9bd34f2023-03-09T06:22:57ZengFrontiers Media S.A.Frontiers in Public Health2296-25652023-03-011110.3389/fpubh.2023.10638061063806Does the implementation of pay-for-performance indicators improve the quality of healthcare? First results in FranceMarc-Antoine Sanchez0Marc-Antoine Sanchez1Stéphane Sanchez2Stéphane Sanchez3Leila Bouazzi4Louise Peillard5Aline Ohl-Hurtaud6Catherine Quantin7Catherine Quantin8Information Systems and Digital Department, French Military Health Service, Saint-Mandé, FranceCentre de recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Université Paris-Saclay, Inserm, High-Dimensional Biostatistics for Drug Safety and Genomics, Villejuif, FranceUniversity Committee of Resources for Research in Health (CURRS), University of Reims, Champagne-Ardenne, Reims, FrancePole Territorial Santé Publique et Performance, Hôpitaux Champagne Sud, Troyes, FranceUniversity Committee of Resources for Research in Health (CURRS), University of Reims, Champagne-Ardenne, Reims, FrancePole Territorial Santé Publique et Performance, Hôpitaux Champagne Sud, Troyes, FranceGeneral Practice Department, University of Reims Champagne-Ardenne, Reims, FranceClinical Epidemiology and Clinical Trials Unit, Biostatistics and Bioinformatics (DIM), Centre d'Investigation Clinique 1432, Clinical Investigation Center, Dijon University Hospital, Dijon, FranceInserm, Centre de recherche en Epidémiologie et Santé des Populations, Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Villejuif, FranceBackgroundPay-for-performance (P4P) models are intended to promote quality of care in both hospitals and primary care settings. They are considered as a means of changing medical practices, particularly in primary care.ObjectivesThe first objective of this study was to assess how performance indicators changed over time, measured through “Remuneration on Public Health Objectives” (ROSP) scores, between 2017 and 2020 in a large French region (Grand Est region), and to compare this evolution in the rural vs. urban areas of the region. The second objective was to focus on the area with the least improvement in ROSP scores and to investigate whether the scores and the available sociodemographic characteristics of the area were associated.MethodsFirst, we measured the evolution over time of P4P indicators (i.e., ROSP scores) obtained from the regional health insurance system, for GP practices in the Grand Est region between 2017 and 2020. We then compared the scores between the Aube Department and the rest of the region (urban areas). To address the second objective, we focused on the area found to have the least improvement in indicators to investigate whether there was a relationship between ROSP score and sociodemographic characteristics.ResultsMore than 40,000 scores were collected. We observed an overall improvement in scores over the study period. The urban area (Grand Est region minus the Aube) scored better than the rural area (Aube) for chronic disease management [median 0.91 (0.84–0.95) vs. 0.90(0.79–0.94), p < 0.001] and prevention [median 0.36 (0.22–0.45) vs. 0.33 (0.17–0.43), p < 0.001], but not for efficiency, where the rural area (Aube) performed better [median 0.67(0.56–0.74) vs. 0.69 (0.57–0.75 in the rest of the Grand Est region, p = 0.004]. In the rural area, we found no significant association between ROSP scores and sociodemographic characteristics, except for extreme rurality in some sub-areas.ConclusionsAt the regional level, the overall improvement in scores observed between 2017 and 2020 suggests that the implementation of ROSP indicators have improved the quality of care, particularly in urban areas. These results also suggest that efforts should be focused on rural areas, which already had the lowest scores at the start of the P4P program.https://www.frontiersin.org/articles/10.3389/fpubh.2023.1063806/fullpay-for-performance (P4P)general practitionerquality of careP4PFrance |
| spellingShingle | Marc-Antoine Sanchez Marc-Antoine Sanchez Stéphane Sanchez Stéphane Sanchez Leila Bouazzi Louise Peillard Aline Ohl-Hurtaud Catherine Quantin Catherine Quantin Does the implementation of pay-for-performance indicators improve the quality of healthcare? First results in France Frontiers in Public Health pay-for-performance (P4P) general practitioner quality of care P4P France |
| title | Does the implementation of pay-for-performance indicators improve the quality of healthcare? First results in France |
| title_full | Does the implementation of pay-for-performance indicators improve the quality of healthcare? First results in France |
| title_fullStr | Does the implementation of pay-for-performance indicators improve the quality of healthcare? First results in France |
| title_full_unstemmed | Does the implementation of pay-for-performance indicators improve the quality of healthcare? First results in France |
| title_short | Does the implementation of pay-for-performance indicators improve the quality of healthcare? First results in France |
| title_sort | does the implementation of pay for performance indicators improve the quality of healthcare first results in france |
| topic | pay-for-performance (P4P) general practitioner quality of care P4P France |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1063806/full |
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