Do pay-for-performance incentives lead to a better health outcome?

摘要

Pay-for-performance approaches have been widely adopted in order to driveimprovements in the quality of healthcare provision. Previous studiesevaluating the impact of these programs are either limited by the number ofhealth outcomes or of medical conditions considered. In this paper, we evaluatethe effectiveness of a pay-for-performance program on the basis of five healthoutcomes and across a wide range of medical conditions. The context of thestudy is the Lombardy region in Italy, where a rewarding program was introducedin 2012. The policy evaluation is based on a difference-in-differencesapproach. The model includes multiple dependent outcomes, that allowquantifying the joint effect of the program, and random effects, that accountfor the heterogeneity of the data at the ward and hospital level. Our resultsshow that the policy had a positive effect on the hospitals' performance interms of those outcomes that can be more influenced by a managerial activity,namely the number of readmissions, transfers and returns to the surgery room.No significant changes which can be related to the pay-for-performanceintroduction are observed for the number of voluntary discharges and formortality. Finally, our study shows evidence that the medical wards havereacted more strongly to the pay-for-performance program than the surgicalones, whereas only limited evidence is found in support of a different policyreaction across different types of hospital ownership.