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Patient Opinions Regarding ‘Pay for Performance for Patients’

  • Judith A. LongEmail author
  • Marie Helweg-Larsen
  • Kevin G. Volpp
Original Article

Abstract

Background

Pay for performance (P4P) programs have shown only modest improvements in outcomes and do not target patient behaviors. Many large employers and payers are turning to pay for performance for patients (P4P4P) to reduce health costs and improve the health of their covered populations. How these programs may be perceived by patients is unknown.

Objective

To assess patients’ opinion of the acceptability of P4P4P.

Design

Cross-sectional self-administered survey.

Participants

Patients in waiting rooms in two university-based primary care clinics.

Measurements

Participants were asked their opinions about paying people to quit smoking, lose weight, control their blood pressure, or control their diabetes.

Results

Respondents were split on whether P4P4P is desirable. Thrity-six to 42% thought it was a good/excellent idea to pay smokers to quit smoking, obese people to lose weight, people with hypertension to control their blood pressure, or people with diabetes to control their blood sugar, while 41–44% of the sample thought it was a bad/very bad idea. Smokers and patients who were obese endorsed P4P4P more favorably as a means to achieving tobacco cessation and weight loss than their non-smoking and non-obese counterparts.

Conclusions

Acceptance of paying patients for performance by the general population is equivocal. Establishing the efficacy of paying patients for performance may help it gain wider acceptance.

KEY WORDS

pay for performance patient acceptance of health care financial management 

Notes

Acknowledgements

The work in this paper was supported by a grant from the Commonwealth of Pennsylvania, titled Collaboration to Reduce Disparities in Hypertension, grant no. ME-02-382.

The Commonwealth bears no responsibility for the content of this article. This paper was presented as a poster at the Society of General Internal Medicine 2007 National Meeting in Toronto, Canada, 2007.

Conflict of Interest

Drs. Long and Helweg-Larsen have no conflicts of interest in relationship to this work. Dr. Volpp received an honorarium from Astra Zeneca for convening a conference on medication adherence as well as receiving investigator initiated grant support from Pfizer for ongoing patient follow-up for a randomized controlled trial of copayment reductions that was initiated through the grant that also supported this work (the Commonwealth of Pennsylvania sponsored Collaboration to Reduce Disparities in Hypertension, grant no. ME-02-382).

Supplementary material

11606_2008_739_MOESM1_ESM.pdf (53 kb)
ESM 1 (PDF 53.4 KB)

References

  1. 1.
    Galvin R. Evaluating the performance of pay for performance. Med Care Res Rev. 2006;63(1):126S–130S.PubMedCrossRefGoogle Scholar
  2. 2.
    Epstein AM, Lee TH, Hammel MB. Paying physicians for high-quality care. New Engl J Med. 2004;350(4):406–410.PubMedCrossRefGoogle Scholar
  3. 3.
    Epstein AM. Paying for performance in the United States and abroad. New Engl J Med. 2006;355(4):406–408.PubMedCrossRefGoogle Scholar
  4. 4.
    Doran T, Fullwood C, Gravelle H, et al. Pay-for-performance programs in family practices in the United Kingdom. New Engl J Med. 2006;355(4):375–384.PubMedCrossRefGoogle Scholar
  5. 5.
    Chassin MR. Does paying for performance improve the quality of health care? Med Care Res Rev. 2006;631(1):22S–125S.PubMedCrossRefGoogle Scholar
  6. 6.
    Petersen LA, Woodard LD, Urech T, Daw C, Sookanan S. Does pay-for-performance improve the quality of health care? Annals Int Med. 2006;145(4):265–272.Google Scholar
  7. 7.
    Glickman SW, Ou FS, DeLong ER, et al. Pay for performance, quality of care, and outcomes in acute myocardial infarction. JAMA. 2007;297(21):2373–2380.PubMedCrossRefGoogle Scholar
  8. 8.
    Lindenauer PK, Remus D, Roman S, Rothberg MB, Benjamin EM, Ma A, Bratzler DW. Public reporting and pay for performance in hospital quality improvement. New Engl J Med. 2007;356(5):486–496.PubMedCrossRefGoogle Scholar
  9. 9.
    Rosenthal MB, Frank RG, Li Z, Epstein AM. Early experience with pay-for-performance: from concept to practice. JAMA. 2005;294(14):1788–1793.PubMedCrossRefGoogle Scholar
  10. 10.
    Schroeder SA. Shattuck Lecture. We can do better - improving the health of the American People. New Engl J Med. 2007;357(12):1221–1228.PubMedCrossRefGoogle Scholar
  11. 11.
    Centers for Disease Control and Prevention. Annual smoking-attributable mortality, years of potential life lost, and economic costs- United States, 1995–1999. MMWR Morb Mortal Wkly Rep. 2002;51(14):300–303.Google Scholar
  12. 12.
    Finkelstein EA, Fiebelkorn IC, Wang G. National medical spending attributable to overweight and obesity: how much, and who’s paying? Health Aff (Millwood). Jan–Jun 2003;Suppl Web Exclusives:W3-219-226. http://content.healthaffairs.org/cgi/content/full/hlthaff.w3.219v1/DC1 Last Accessed July 2, 2008
  13. 13.
    Yi D. For Many Employees, Fitness has its Prize. Los Angeles Times, March 12 2007.Google Scholar
  14. 14.
    Mcqueen MP. Wellness plans reach out to the healthy. Wall Street Journal Abstracts, 2007;March 28: D1.Google Scholar
  15. 15.
    Jordan S. Financial carrot is a healthy incentive, more companies use enticing benefits to lure workers into wellness programs. Omaha World Herald, 2007;March 25:A1.Google Scholar
  16. 16.
    Song KM. New health-benefits plan prompts county workers to diet and head for the gym. The Seattle Times, 2006;July 22:A1.Google Scholar
  17. 17.
    Conlin M. Get healthy _ or else. inside one company’s all-out attack on medical costs. Business Week Online, 2007;February 26. Available at http://www.businessweek.com/magazine/content/07_09/b4023001.htm Last Accessed July 2, 2008
  18. 18.
    Steinbrook R. Imposing personal responsibility for health. New Engl J Med. 2006;355(8):753–756.PubMedCrossRefGoogle Scholar
  19. 19.
    West Virginia’s Medicaid State Plan Amendment (SPA) 06-02, approved by the Centers for Medicare & Medicaid Services, Department of Health and Human Services, May 3, 2006. Available at http://www.wvdhhr.org/bms/oAdministration/bms_admin_WV_SPA06-02_20060503.pdf Last Accessed July 2, 2008
  20. 20.
    Donatelle RJ, Hudson D, Dobie S, Goodall A, Hunsberger M, Oswald K. Incentives in smoking cessation: status of the field and implications for research and practice with pregnant smokers. Nicotine & Tobacco Research. 2004;9(Supplement 2):S163–S179.CrossRefGoogle Scholar
  21. 21.
    Volpp KG, Gurmankin Levy A, Asch DA, et al. A randomized controlled trial of financial incentives for smoking cessation. Cancer Epidemiol Biomarkers Prev. 2006;15(1):12–18, Jan.PubMedCrossRefGoogle Scholar
  22. 22.
    Lussier JP, Heil SH, Mongeon JA, Badger GJ, Higgins ST. A meta-analysis of voucher-based reinforcement therapy for substance use disorders. Addiction. 2005;101:102–203.Google Scholar
  23. 23.
    Higgins ST, Silverman K, eds. Motivating Behavior Change Among Illicit Drug Abusers: Research on Contingency Management Interventions. Washington, DC: American Psychological Association; 1999.Google Scholar
  24. 24.
    Marcus AC, Kaplan CP, Crane LA, et al. Reducing loss-to-follow-up among women with abnormal Pap smears. Results from a randomized trial testing an intensive follow-up protocol and economic incentives. Med Care. 1998;36(3):397–410, Mar.PubMedCrossRefGoogle Scholar
  25. 25.
    Stevens-Simon C, O’Connor P, Bassford K. Incentives enhance postpartum compliance among adolescent prenatal patients. J Adolesc Health. 1994;15(5):396–399, Jul.PubMedCrossRefGoogle Scholar
  26. 26.
    Malotte CK, Rhodes F, Mais KE. Tuberculosis screening and compliance with return for skin test reading among active drug users. Am J Public Health. 1998;88(5):792–796, May.PubMedCrossRefGoogle Scholar
  27. 27.
    Seal KH, Kral AH, Lorvick J, McNees A, Gee L, Edlin BR. A randomized controlled trial of monetary incentives vs. outreach to enhance adherence to the hepatitis B vaccine series among injection drug users. Drug Alcohol Depend. 2003;71(2):127–131, Aug 20.PubMedCrossRefGoogle Scholar
  28. 28.
    Jeffery RW, Thompson PD, Wing RR. Effects on weight reduction of strong monetary contracts for calorie restriction or weight loss. Behav Res Ther. 1978;16(5):363–369.PubMedCrossRefGoogle Scholar
  29. 29.
    Finkelstein EA, Linnan LA, Tate DF, Birken BE. A pilot study testing the effect of different levels of financial incentives on weight loss among overweight employees. J Occup Environ Med. 2007;49(9):981–989, Sep.PubMedCrossRefGoogle Scholar
  30. 30.
    Jeffery RW, Gerber WM, Rosenthal BS, Lindquist RA. Monetary contracts in weight control: effectiveness of group and individual contracts of varying size. J Consult Clin Psychol. 1983;51(2):242–248, Apr.PubMedCrossRefGoogle Scholar
  31. 31.
    Sindelar J, Elbel B, Petry NM. What do we get for our money? Cost-effectiveness of adding contingency management. Addiction. 2007;102(2):309–316, Feb.PubMedCrossRefGoogle Scholar
  32. 32.
    Sindelar JL, Olmstead TA, Peirce JM. Cost-effectiveness of prize-based contingency management in methadone maintenance treatment programs. Addiction. 2007;102(9):1463–1471, Sep.PubMedCrossRefGoogle Scholar
  33. 33.
    Kane RL, Johnson PE, Town RJ, Butler M. A structured review of the effect of economic incentives on consumers’ preventive behavior. Am J Prev Med. 2004;27(4):327–352.PubMedCrossRefGoogle Scholar
  34. 34.
    Tversky A, Kahneman D. The framing of decisions and the psychology of choice. Science. 1981;211:453–458.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Judith A. Long
    • 1
    • 2
    • 3
    Email author
  • Marie Helweg-Larsen
    • 4
  • Kevin G. Volpp
    • 1
    • 2
    • 3
    • 5
  1. 1.Philadelphia VA Center for Health Equity Research and PromotionPhiladelphiaUSA
  2. 2.University of Pennsylvania School of MedicinePhiladelphiaUSA
  3. 3.University of Pennsylvania Leonard Davis Institute for Health EconomicsPhiladelphiaUSA
  4. 4.Dickinson CollegeCalisleUSA
  5. 5.Department of Health Care Systemsthe Wharton SchoolPhiladelphiaUSA

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