This is the protocol for a review and there is no abstract. The objectives are as follows:
The aim of this review is to examine the effect of changes in financial incentives on the quality of care provided by primary care physicians (PCPs) and to identify:
i) the different types of financial incentives that have improved quality,
ii) the characteristics of patient populations for whom quality of care has been improved by financial incentives,
iii) the characteristics of PCPs who have responded to financial incentives.
Differences with previous Cochrane reviews
Our review is broader than the two previous Cochrane reviews in this area with respect to the type of financial incentives, but also narrower with respect to the outcome measures being used (Gosden 2000; Giuffrida 1999). Both existing reviews examine primary care physicians, and we retain this focus.
Type of financial incentives:
Giuffrida 1999 focuses only on target payments, which are when payments are made when a specific level of activity or quality is reached. This is a specific type of non-linear performance pay. Gosden 2000 considers interventions that change the type of payment between salary, capitation and fee-for-service (FFS). Our review includes all of these types of payments, in addition to changes in the level or amount of payment, pay for performance schemes, changes to who is paid (e.g. the physician or team), in addition to multifaceted interventions that include a mix of the above with a non-financial intervention (e.g. education).
Outcome measures used:
Another difference with these reviews is the type of outcomes considered. In Giuffrida 1999 studies were included if they reported objective measurement of patient outcomes, health services utilization, health care costs, equity of care and PCP satisfaction with working environment. Gosden 2000 report similar outcomes as studies were included only if they reported objective measures of: health professional outcomes, health professional process, health service utilization, health care costs, and patient outcomes. Our review defines quality of care in terms of clinical behaviours, clinical and physiological measures, and patient reported outcome measures and experiences. It excludes health professional processes and outcomes, and health care costs.