title: The influence of performance-based payment on childhood immunisation coverage.
abstract: BACKGROUND
  Pay-for-performance, also called the quality system (QS) in Estonia, was implemented in 2006 and one indicator for achievement is the childhood immunisation coverage rate. The WHO vaccination coverage in Europe for diphtheria, tetanus and pertussis, and measles in children aged around one year old should meet or exceed 90 per cent.
  
  
  METHODS
  The study was conducted using a database from the Estonian Health Insurance Fund. The study compared childhood immunisation coverage rates of all Estonian family physicians in two groups, joined and not joined to the quality system during the observation period 2006-2012. Immunisation coverage was calculated as the percentage of persons in the target age group who received a vaccine dose by a given age. The target level of immunisations in Estonia is set at 90 per cent and higher.
  
  
  RESULTS
  Immunisation coverage rates of family doctors (FD) in Estonia showed significant differences between two groups of doctors: joined to the quality system and not joined. Doctors joined to the quality system met the 90 per cent vaccination criterion more frequently compared to doctors not joined to the quality system. Doctors not joined to the quality system were below the 90 per cent vaccination criterion in all vaccinations listed in the Estonian State Immunisation Schedule.
  
  
  CONCLUSIONS
  Pay-for-performance as a financial incentive encourages higher levels of childhood immunisations.
authors: Department of Family Medicine, University of Tartu, Puusepa 1a, 50406 Tartu, Estonia. Electronic address: eero.merilind@arst.ee.
authors: Eero
authors: E
authors: Merilind
authors: Klaster Baltic, Gildi 12, 51007 Tartu, Estonia.
authors: Rauno
authors: R
authors: Salupere
authors: Estonian Health Insurance Fund, Lembitu 10, 10114 Tallinn, Estonia.
authors: Katrin
authors: K
authors: Västra
authors: Department of Family Medicine, University of Tartu, Puusepa 1a, 50406 Tartu, Estonia.
authors: Ruth
authors: R
authors: Kalda
mesh_terms: D002648:Child; D002675:Child, Preschool; D004957:Estonia; D005194:Family Practice / Q000706:statistics & numerical data; D006801:Humans; D017589:Immunization Programs; D007115:Immunization Schedule; D007223:Infant; D011787:Quality of Health Care / Q000592:standards; D012052:Reimbursement, Incentive / Q000706:statistics & numerical data*; D014611:Vaccination / Q000191:economics* / Q000706:statistics & numerical data
keywords: Childhood immunisations; Family practice; Health care quality; Immunisation coverage rate; Pay-for-performance