PUP 4931r Lecture Notes - Lecture 56: Financial Transaction, Day Care
16 May 2018
School
Department
Course
Professor
Physician P4P
Very Limited US Evidence:
Many critics of the concepts
Himmelstein, Ariley and Woolhammer, 2014.
P4P Assumptions
Measures of perforae reflet the liiias’ perforae
Current payment system too simple
more detailed contracts would motivate improvement
Variation in performance reflects motivation
Financial incentives will add performance motivation
Physicians performing poorly should get less money
Challenges to P4P Assumptions
Patiets’ health shaped y ay fators
Bad outcomes sometimes follow good care
Outcomes lag, causality untraceable
Risk adjustors are inaccurate
Detailed contracts have high transactions costs.
May replace professional motivation and good will with legal specification,
paperwork, legal challenges.
Vitiates default to good will for omitted items.
Evidence of Poor Motivation Lacking
Lots of evidence that many other factors interfere with quality
Commercial influence, knowledge gaps, memory lapses, poor interpersonal
skills, insufficient teamwork.
But no eidee it’s poor otiatio.
Extrinsic Reward May Be Harmful
Lots of studies showing that students and others in experimental studies play
puzzles, donate blood, volunteer
find more resources at oneclass.com
find more resources at oneclass.com
