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Effects of Monetary Incentives in Physician Groups: A Systematic Review of Reviews.

ABSTRACT: BACKGROUND:Reimbursement systems that contribute to the cooperation and integration of providers have become increasingly important within the healthcare sector. Reimbursement systems not only serve as payment mechanisms but also provide control and incentive functions. Thus, the design of reimbursement systems is extremely important. OBJECTIVES:The aims of this systematic review were to describe and gain a better understanding of the effects of monetary incentives in the setting of physician groups. METHODS:In January 2020, we searched the MEDLINE (PubMed), Cochrane Library, CINAHL, PsycINFO, EconLit, and ISI Web of Science databases as well as the gray literature and authors' personal collections. RESULTS:We included 21 reviews containing seven different incentive schemes/initiatives. The study settings and outcome measures varied considerably, as did the results within the incentive schemes and initiatives. However, we found positive effects on process quality for two types of incentives: pay-for-performance and accountable care organizations. The main limitations of this review were the variations in study settings and outcome measures of the studies included. CONCLUSIONS:Monetary incentives in healthcare are often implemented as a control measure and are supposed to increase quality of care and reduce costs. The heterogeneity of the study results indicates that this is not always successful. The results reveal a need for research into the effects of monetary incentives in healthcare.

SUBMITTER: Heider AK

PROVIDER: S-EPMC7519000 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Effects of Monetary Incentives in Physician Groups: A Systematic Review of Reviews.

Heider Ann-Kathrin AK Mang Harald H

Applied health economics and health policy 20201001 5

<h4>Background</h4>Reimbursement systems that contribute to the cooperation and integration of providers have become increasingly important within the healthcare sector. Reimbursement systems not only serve as payment mechanisms but also provide control and incentive functions. Thus, the design of reimbursement systems is extremely important.<h4>Objectives</h4>The aims of this systematic review were to describe and gain a better understanding of the effects of monetary incentives in the setting ...[more]

PMID: 32207083

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Project description:ImportanceSignificant controversy exists regarding whether physicians factor personal financial considerations into their clinical decision making. Within oncology, several reimbursement policies may incentivize physicians to increase health care use.ObjectiveTo evaluate whether the financial incentives presented by oncology reimbursement policies affect physician practice patterns.Evidence reviewStudies evaluating an association between reimbursement incentives and changes in reimbursement policy on oncology care delivery were reviewed. Articles were identified systematically by searching PubMed/MEDLINE, Web of Science, Proquest Health Management, Econlit, and Business Source Premier. English-language articles focused on the US health care system that made empirical estimates of the association between a measurement of physician reimbursement/compensation and a measurement of delivery of cancer treatment services were included. The Risk of Bias in Non-Randomized Studies of Interventions tool was used to assess risk of bias. There were no date restrictions on the publications, and literature searches were finalized on February 14, 2018.FindingsEighteen studies were included. All were observational cohort studies, and most had a moderate risk of bias. Heterogeneity of reimbursement policies and outcomes precluded meta-analysis; therefore, a qualitative synthesis was performed. Most studies (15 of 18 [83%]) reported an association between reimbursement and care delivery consistent with physician responsiveness to financial incentives, although such an association was not identified in all studies. Findings consistently suggested that self-referral arrangements may increase use of radiotherapy and that profitability of systemic anticancer agents may affect physicians' choice of drug. Findings were less conclusive as to whether profitability of systemic anticancer therapy affects the decision of whether to use any systemic therapy.Conclusions and relevanceTo date, this study is the first systematic review of reimbursement policy and clinical care delivery in oncology. The findings suggest that some oncologists may, in certain circumstances, alter treatment recommendations based on personal revenue considerations. An implication of this finding is that value-based reimbursement policies may be a useful tool to better align physician incentives with patient need and increase the value of oncology care.

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Effects of Monetary Incentives in Physician Groups: A Systematic Review of Reviews.

Publications

Effects of Monetary Incentives in Physician Groups: A Systematic Review of Reviews.

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