Financial incentives may be effective in changing healthcare professional practice .
We found no evidence from review s that examined the effect of financial incentives on patient outcomes
BACKGROUND There is considerable interest in the effectiveness of financial incentives in the delivery of health care .
Incentives may be used in an attempt to increase the use of evidence -based treatments among healthcare professionals or to stimulate health professionals to change their clinical behaviour with respect to preventive , diagnostic and treatment decisions , or both .
Financial incentives are an extrinsic source of motivation and exist when an individual can expect a monetary transfer which is made conditional on acting in a particular way .
Since there are numerous review s performed within the healthcare area describing the effects of various types of financial incentives , it is important to summarise the effectiveness of these in an overview to discern which are most effective in changing health professionals ' behaviour and patient outcomes .
OBJECTIVES To conduct an overview of systematic review s that evaluates the impact of financial incentives on healthcare professional behaviour and patient outcomes .
Changing remuneration systems: effects on activity in general practice.
OBJECTIVE --To investigate the effects on general practitioners ' activities of a change in their remuneration from a capitation based system to a mixed fee per item and capitation based system . DESIGN --Follow up study with data collected from contact sheets completed by general practitioners in one period before ( March 1987 ) a change in their remuneration system and two periods after ( March 1988 , November 1988 ) , with a control group of general practitioners with a  mixed fee per item and capitation based system  throughout . SETTING --General practice s in Copenhagen city ( index group ) and Copenhagen county ( control group ) . SUBJECTS--265 General practitioners in Copenhagen city , of whom 100 were selected r and omly from the 130 who agreed to participate ( 10 exclusions ) and 326 general practitioners in Copenhagen county . MAIN OUTCOME MEASURES --Number of consultations ( face to face and by telephone ) and renewals of prescriptions , diagnostic and curative services , and specialist and hospital referrals per 1000 enlisted patients in one week . RESULTS --Of the 75 general practitioners who completed all three sheets , four were excluded for incomplete data . Total contact rates per 1000 patients listed rose significantly compared with the rates before the change index in the city ( 100.0 before the change v 111.7 ( 95 % confidence interval 106.4 to 117.4 after the change ) and over the same time in the control group ( 100.0 v 106.0 ) , but within a year these rates fell ( to 104.2(99.1 to 109.6 ) and 104.0 respectively ) . There was an increase in consultations by telephone initially but not thereafter . Rates of examinations and treatments that attracted specific additional remuneration after the change rose significantly compared with those before ( diagnostic services , 138.1 ( 118.7 to 160.5 ) and 159.5 ( 137.8 to 184.7 ) and curative services 194.6 ( 152.2 to 248.9 ) and 194.8(152.3 to 249.2 ) for second and third data collection s respectively ) and with the control group ( diagnostic services 105.3 , 107.6 and curative services 106.0 , 115.0 ) whereas referral rates to secondary care fell ( specialist referrals 90.1 ( 80.7 to 100.6 ) and 77.0 ( 68.6 to 86.4 ) and hospital referrals 87.4 ( 71.1 to 107.5 ) and 68.4 ( 54.7 to 85.4 ] in doctors in the city . CONCLUSIONS --Introducing a partial fee for service system seemed to stimulate the provision of services by general practitioners , result ing in reduced referral rates . The concept of a " target income " which doctors aim at , rather than maximising their income seemed to play a part in adjustment to changing the system of remuneration
Financial incentives may be effective in changing healthcare professional practice .
We found no evidence from review s that examined the effect of financial incentives on patient outcomes
BACKGROUND There is considerable interest in the effectiveness of financial incentives in the delivery of health care .
Incentives may be used in an attempt to increase the use of evidence -based treatments among healthcare professionals or to stimulate health professionals to change their clinical behaviour with respect to preventive , diagnostic and treatment decisions , or both .
Financial incentives are an extrinsic source of motivation and exist when an individual can expect a monetary transfer which is made conditional on acting in a particular way .
Since there are numerous review s performed within the healthcare area describing the effects of various types of financial incentives , it is important to summarise the effectiveness of these in an overview to discern which are most effective in changing health professionals ' behaviour and patient outcomes .
OBJECTIVES To conduct an overview of systematic review s that evaluates the impact of financial incentives on healthcare professional behaviour and patient outcomes .