What would happen if doctors were able to receive financial incentives for screening for certain types of diseases, or for helping patients to quit smoking? Would this lead to an improvement in health care? Research shows that sometimes it does, and other times it does not.
There have been a lot of suggestions about how to make improvements to the current health care system in the United States. Some of these ideas have become laws that directly affect health insurance. Other ideas are more focused on ways to lower the cost of health insurance, and to improve the care that doctors give their patients.
It seems that there are two different types of situations that relate to health care and that can be called “incentives”. There is one kind of incentive that is given to the consumers who have a health insurance policy. A company that offers employer sponsored health insurance might give a prize of some kind to employees who lose weight, or stop smoking.
The other type of incentive is given to doctors who provide their patients with specific kinds of health care. The hope is that the doctors will be motivated by the possibility of receiving a financial incentive, and therefore, will give even better care to his patients.
Does that really work? A group of Australian researchers did some studies in order to find out. They collected information about incentive programs that took place in three countries: the US, the UK, and Germany.
The researchers checked to see if a financial incentive made any difference in how often doctors did certain things like: screening for different diseases, referring patients to follow-up care, or to achieve a specific health outcome (for example, helping a patient to quit smoking).
The study focused on each individual doctor’s behavior right before an incentive program started and after it ended. They also compared the behaviors of doctors who were participating in incentive programs with those who were not.
The incentives were being awarded in different ways. Some doctors were getting a small payment every time they helped a patient to quit smoking. Some clinics were getting one large payment after they hit a goal of a total number of patients that were referred to a helpline for quitting smoking. These clinics could earn additional money for each extra referral over that total number.
They found out that the doctors who were already doing those things, before the incentive was offered, simply continued to do them. These doctors were able to receive the money from the incentive without having to change their behavior at all.
Other results were mixed. Some of the clinics that were getting an incentive for referring smokers to a helpline sent about 11% of their patients there. The clinics that were not getting any incentives only sent about 4% of their patients to the helpline. In other cases, doctors did not appear to screen more often for certain types of diseases even if they were promised a financial payout for doing so.
The least effective type of incentive were the ones that ranked groups of doctors against each other, and based their award on that ranking. This actually encouraged doctors who did not expect to rank very high to not put any effort into making changes.
Image by Images_of_Money on Flickr