An examination of pay-for-performance in general practice in Australia.
OBJECTIVE
This study examines the impact of Australia's pay-for-performance (P4P) program for general practitioners (GPs). The voluntary program pays GPs A$40 and A$100 in addition to fee-for-service payment for providing patients recommended diabetes and asthma treatment over a year, and A$35 for screening women for cervical cancer who have not been screened in 4 years.


METHODS
Three approaches were used to triangulate the program's impact: (1) analysis of trends in national claims for incentivized services pre- and postprogram implementation; (2) fixed effects panel regression models examining the impact of GPs' P4P program participation on provision of incentivized services; and (3) in-depth interviews to explore GPs' perceptions of their own response to the program.


RESULTS
There was a short-term increase in diabetes testing and cervical cancer screens after program implementation. The increase, however, was for all GPs. Neither signing onto the program nor claiming incentive payments was associated with increased diabetes testing or cervical cancer screening. GPs reported that the incentive did not influence their behavior, largely due to the modest payment and the complexity of tracking patients and claiming payment.


CONCLUSIONS
Monitoring and evaluating P4P programs is essential, as programs may not spark the envisioned impact on quality improvement.
George Washington University School of Nursing, Washington, DC 20036, USA. jessgreene@gwu.edu
Jessica
J
Greene
D001249:Asthma / Q000628:therapy; D001291:Attitude of Health Personnel; D001315:Australia; D003920:Diabetes Mellitus / Q000175:diagnosis; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D005260:Female; D058006:General Practice / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration / Q000706:statistics & numerical data; D015397:Program Evaluation; D012051:Reimbursement Mechanisms / Q000458:organization & administration / Q000706:statistics & numerical data; D012052:Reimbursement, Incentive / Q000458:organization & administration* / Q000706:statistics & numerical data; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis; D035141:Voluntary Programs / Q000458:organization & administration / Q000706:statistics & numerical data
Pay-for-performance; chronic disease care; quality improvement; quality of care