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Pay-for-Performance: Impact on Diabetes

  • Health Care Delivery Systems in Diabetes (D Wexler, Section Editor)
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Abstract

Pay-for-performance schemes explicitly link provider remuneration to the quality of care provided, with the aims of modifying provider behavior and improving patient outcomes. If successful, pay-for-performance schemes could drive improvements in quality and efficiency of care. However, financial incentives could also erode providers’ intrinsic motivation, narrow their focus, promote unethical behavior, and ultimately increase health care inequalities. Evidence from schemes implemented to date suggests that carefully designed pay-for-performance schemes that align sufficient rewards with clinical priorities can produce modest but significant improvements in processes of diabetic care and intermediate outcomes. There is limited evidence, however, on whether improvements in processes of care result in improved outcomes, in terms of patient satisfaction, reduced complications, and greater longevity. The lack of adequate control groups has limited research findings to date, and more robust studies are needed to explore both the potential long-term benefits of pay-for-performance schemes and their unintended consequences.

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Acknowledgments

T.D. conducted the literature review and drafted and edited the text. E.K. analyzed and interpreted the data for the exhibits and edited the text. This work received no specific funding, and this article was externally peer reviewed.

T.D. was supported by a National Institute for Health Research (NIHR) Career Development Fellowship. This report is independent research, and the views expressed are those of the author and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health. E.K. was supported by a NIHR School of Primary Care Research fellowship in primary health care.

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  1. Institute of Population Health, University of Manchester, Williamson Building Oxford Road, Manchester, M13 9PL, UK

    Tim Doran & Evangelos Kontopantelis

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  1. Tim Doran
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  2. Evangelos Kontopantelis
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Correspondence to Tim Doran.

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Doran, T., Kontopantelis, E. Pay-for-Performance: Impact on Diabetes. Curr Diab Rep 13, 196–204 (2013). https://doi.org/10.1007/s11892-012-0351-y

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