Financial incentives to hospitals that serve poor patients

January 01, 0001

Financial incentives to hospitals that serve poor patients

These US authors sought to determine how financial incentives for quality performance affect hospitals with more poor patients compared with those with fewer poor patients in a retrospective observational study. Participant hospitals were 251 that participated in the Premier Hospital Quality Incentive Demonstration program and a national sample of 3017 hospitals. They measured the association between the disproportionate-share index, a marker of caring for poor patients, and baseline quality performance, changes in performance, and terminal performance for acute myocardial infarction, congestive heart failure, and pneumonia for hospitals in the pay- for-performance program and those in the national sample (which did not receive financial incentives).

They found: "Among both pay-for-performance hospitals and those in the national sample, hospitals with more poor patients had lower baseline performance than did those with fewer poor patients. A high disproportionate- share index was associated with greater improvements in performance for acute myocardial infarction and pneumonia but not for congestive heart failure, and the gains were greater among hospitals that received financial incentives than among the national sample. After 3 years, hospitals that had more poor patients and received financial incentives caught up for all 3 conditions, whereas those with more poor patients among the national sample continued to lag."

The authors concluded: "No evidence indicated that financial incentives widened the gap in performance between hospitals that serve poor patients and other hospitals. Pay-for-performance programs may be a promising quality improvement strategy for hospitals that serve poor patients."

These results suggest that financial incentive is a potentially effective approach to closing the gap in health care disparities.

For the full abstract, click here.

Annals of Internal Medicine 153(5):299-306, 7 September 2010
© 2010 to the American College of Physicians
The Effect of Financial Incentives on Hospitals That Serve Poor Patients. Ashish K. Jha, E. John Orav, and Arnold M. Epstein. Correspondence to Dr. Jha:

Category: Z. Social Problems, HSR. Health Services Research. Keywords: quality of care, pay-for-performance, hospital care, poor patients, acute myocardial infarction, congestive heart failure, pneumonia, retrospective observational study, journal watch.
Synopsis edited by Dr Linda French, Toledo Ohio. Posted on Global Family Doctor 21 September 2010

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