Tim Doran: Consequences of paying for quality in healthcare

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Tim Doran: Consequences of paying for quality in healthcare

  1. 1. The Unintended Consequences of  Paying for Quality in Health Care f l lh Tim Doran University of Manchester Harvard School of Public Health Nuffield Health Strategy Summit, 3 March 2011 Doran NPCRDC Paying Physicians for Quality
  2. 2. • Adverse effect on professionalism and motivation • Neglect of non‐incentivized activities• Widening of health inequalities
  3. 3. Case Study One: Quality and Outcomes Framework Q lit dO t F k Doran NPCRDC Paying Physicians for Quality
  4. 4. Paying for quality The Quality and Outcomes Framework The United Kingdom Results The United StatesInfluenza immunisationInfluenza immunisationIncentivized (CHD) and unincentivized (CKD) 100 95 90 85 ment rate 80 75 Achievem Incentivized 70 Unincentivized 65 60 55 50 2000/1 2001/2 2002/3 2003/4 2004/5 2005/6 2006/7 NPCRDC Paying Physicians for Quality 
  5. 5. Paying for quality The Quality and Outcomes Framework The United Kingdom Results The United StatesUplift in achievementUplift in achievementActual versus expected achievement: Year 1 (2004/5) and Year 3 (2006/7) 35  27  15 = 1 = 7 25  0  6 ent above  ed rate 15  4  2 = 11 = 7 predicte Achieveme 5  5  11 5 ‐5 ‐15 Year 1 Year 1 Year 3 Year 3 NPCRDC Paying Physicians for Quality 
  6. 6. Adventures in Health Care Reform Adventures in Health Care Reform Doran NPCRDC Paying Physicians for Quality
  7. 7. Potomac feverPotomac fever Doran NPCRDC US Health Care Reform
  8. 8. Reform eoPast attempts “Democrats want to create a Democrats government-run system for not providing health care, while care Republicans say coverage is best denied by allowing private insurers to make it unaffordable for as many citizens as possible ” possible. NPCRDC US Health Care Reform

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