Effects of Monetary Incentives in Physician Groups: A Systematic Review of Reviews
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SYSTEMATIC REVIEW
Effects of Monetary Incentives in Physician Groups: A Systematic Review of Reviews Ann‑Kathrin Heider1 · Harald Mang2
© The Author(s) 2020
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.
1 Introduction In health systems all over the world, new reimbursement strategies and systems are tested to improve quality of care and/or reduce expenses. Reimbursement systems not only serve as payment mechanisms but also provide control and incentive functions [1]. Thus, the design of reimbursement systems is extremely important. When providing funding and allocating financial resources, maintaining a balance between appropriate provider remuneration and an adequate level of financial Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40258-020-00572-x) contains supplementary material, which is available to authorized users. * Ann‑Kathrin Heider ann‑[email protected] 1
Faculty of Medicine, Master Program Medical Process Management, Friedrich-Alexander-Universität ErlangenNürnberg (FAU), Erlangen, Germany
Master Program Medical Process Management, Universitätsklinikum Erlangen, Erlangen, Germany
2
burden on payers is important. The above-mentioned controlling function is based on the economic incentives of these payments, which can influence provider behavior [1]. This function often receives special attention during the design phase of a reimbursement system. Incentive systems are deliberately chosen stimuli implemented to achieve a certain degree of behavior control [2]. They can pursue differe
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