Search results for 'P4P'

P4P for French primary care physicians for the first time of their history

26 Jul

For the first time of their history, French primary care practitioners will be paid for performance. Until now their remuneration was only of “fee for service” type. But the new contract with social security scheme of July 2011 introduces a dose of “pay for performance”. Goals that will have to be reached in order to receive bonuses will be fixed by the contract negotiated with the French national social security scheme.

Old time when practitioners only had an obligation of mean is from now on a past history. Bonuses are now also paid for the obtaining of results.

The risk of such a new remuneration is that it only add on to the previous one “fee for service” remuneration without address the problem of repetitive un-necessary medical cares.

Pay for performance should potentially show better results in a salaried context like in England than in a fee for service context like it is in France.

Furthermore patients with multiple chronic diseases often do not correspond to any guidelines available.  But… wait and see.

All the more, results depend on how generous will be the financial incentive and how high will be set the performance thresholds. From now on bonuses costs are estimated between 360 and 380 million Euros.

Le quotidien du médecin

10 Jan

Today is a celebration day. One of the most read daily medical news-paper in France, especially by general practitioners, has just quoted, in its January 9th, 2012 issue, the Health Services Authors blog.


The author of a letter published by the Quotidien du Médecin, Dr Olivier Guilhot, a general practitioner giving primary cares in a disadvantaged suburb of Marseilles, made a reference to two posts of the Health Services Authors blog: this one and this one.
I’m very pleased that this blog could be used as a material in an interesting debate about the risk of moral hazard attached to the declarative side of the financial incentives attribution procedure in the brand new P4P implemented in France last summer. This is the mission statement of health services authors blog to participate and fuel all the discussions in the health services policy provided that they are grounded on sound research results. If I do not endorse the entire contents of the letter nevertheless I was sensitive to some very stylish excerpts like for example the evocation of the ghosts of fathers of the social security system in 1945 (now all dead), victorious of the Nazis, inheriting the solidarity spirit from the concentration camps, assisting to an actual meeting and standing up and leaving the assembly when hearing a health care provider saying that it’s just sufficient to declare you succeeded the objectives to receive the financial incentive. I know the great majority of my colleagues are not that greedy. But here we touch the critical point: the moral hazard like insurers say.

Provider incentives

13 Sep

Provider financial incentives, does it works?  Reuters report some concern on the issue expressed by a Professor of health economy, Jim Burgess, Director of Health Services Research at Boston University.

The US, the UK, Canada, Germany and recently France implement different incentive schemes to reward primary care physicians who perform quality in cares.

But the intervention may lead to adverse effects as observed in those two systematic reviews of the literature, one in 2009 and the other this month of 2011.

Professor Jim Burgess advises to target the whole-patient health instead of limited areas of health as counterpart of rewards for doctors.

We made earlier a post on the subject of pay for performance in France.

US lacks of primary care physicians

27 Jul

In a editorial published in August 31, 2006 in the New England Journal of Medicine the statement was made that US lacks of primary care physicians and the graphic reproduced below with the courtesy of the author gave the reason why: the work is no more attractive for students.  In a previous post we had seen that the reduction of  staff of primary care physicians leads them to refuse appointments for new patients. This matter of fact provokes the anger of the federal administration. This issue is also encountered more and more in France.

Will the new pay for performance measures implemented in France be attractive or repulsive for the new generations?

Indeed the future national primary care payment policy, whatever it will be, will have to take into account these demographic data.


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