HEALTH MANAGEMENT. Financial incentives for doctors do not always help.

NEW YORK (Reuters Health) - health systems, how best to structure financial incentives for primary health care work better, not have found physicians to do, suggests a new paper.
And it is not clear that the incentives to reward doctors, wanted to improve patient care, do more and more good than damage, Australian researchers, data from studies of incentive programs in the United States, and Germany.
In these studies, researchers looked to see if distinguished doctors shown for different diseases, follow-up patients according to or achieved a result of health specific financial incentives such as often-such as a patient, that to quit smoking. Overall, the effects have been mixed.
"Many doctors, who already well simply claim the money with no change in behavior", said Anthony Scott, one of the review authors from the University of Melbourne, Reuters Health in an e-Mail.
"Incentives are not often on such doctors, which targeted the poorest quality of care." And (sometimes) the amount of money may not be sufficient, or doctors are simply not motivated by money from a large part, "he added."
He and his colleagues reviewed seven studies, doctors comparing performance, before and after incentive programs, or compared to the just a regular salary doctors in incentive programs.
Payments have been set up differently: in one case doctors have helped a small payment for each patient, which they smoking; in another model a large payout received clinics after the collision with a goal for the total number of patients a stop smoking helpline referred to additional rewards for each additional references.
Some seemed to help these incentives. Clinics, the incentives for a helpline smokers to get sent around four percent of their patients there, 11 percent rewarded referred to such as always. But in other cases, the promise of a payment does not, that doctors were better at screening for breast cancer or chlamydia.
Also with such as primary care pretty reward doctors, researchers and takes into account many different measures of performance, to fight, Jim Burgess said, health policy studies at Boston University and was not the new review.
"It is to the general problem as you an array of quality measures and try, one way to work the common Assembly and first comprehensive measure of the performance measures", he told Reuters Health.
"" "Most of what has gone before (in trials), has not generated really, what we think of as:"We are really ready to move forward on this.""
Some incentive programs actually can make worse certain doctors, run, or have no effect, he added. Do, for example, in a program, that is one group of doctors and are a payout for those then that on a certain measure-a type of system, which he studied popular - "People who know that she high, can not ranked in fact does not actually change effort."
However, there are hundreds of different incentive schemes, in the United States and Canada set up, said Scott. And the strategies in U.S. health care reform is part of cost-cutting by rewarding physicians who perform well.
The researchers were firm in their report, published in the Cochrane Library, that further study is needed to find out how to pay off financial rewards for patients and health systems. For now, they said any new incentive programs,-should be made, and takes into account unintended consequences.
The idea, said Burgess, to use 'tried take a broader view of patients' health very patient as a basis for doctors for the good work rewarding.

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