The Price of Good Care

Death rates may decrease in hospitals given quality care financial incentives

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) A little bonus cash goes a long way, even in the quality of treatment at a hospital. The number of deaths go down among hospitals paid bonuses for quality work in the UK, new research has found.

The healthcare system in the UK, which has been socialized for years, had not included payment and economic incentives in the past. They have now changed their perspective.

“Pay-for-performance schemes are being widely adopted, yet until now there’s been little evidence that they improve patient outcomes," according to researchers.

"Know the ER before going to the hospital."

Though it's a hot topic among health consumers, hospitals in the northwest region of the UK were paid bonuses based on the quality of care given in the emergency room. The program, called Advancing Quality, came out in 2008 at 24 hospitals that provide emergency care. It requires hospitals to keep track of 28 different quality measures under five medical conditions.

The study, led by Ruth McDonald, PhD, professor of Healthcare Innovation and Learning at Nottingham University Business School, looked at how the schemes affect the number of deaths among patients who had at least one of three conditions, including pneumonia, heart attacks and heart failure.

The data included about a million patients with more than 134,000 in hospitals that took part in the program. They also looked at the number of deaths during hospital stays of at least 30 days in the 18 months before and after the program was introduced.

Over 18 months, the risk of death dropped 1.3 percent, or saved 900 lives, researchers found. 

Between large and small hospitals, there were few differences in the number of deaths, although small hospitals and those with 'excellent' or 'good' service had the largest decrease in the number of deaths.

Similar programs in the US did not yield as high of a result.

“Research on pay-for-performance initiatives in the US has shown their effect on hospitals’ care processes to be at best modest and short-term," Dr. McDonald said in a press release.

"Evidence of an effect on patient outcomes has been even weaker, with the largest scheme apparently having no impact on patient mortality. So we have to ask ourselves what made a difference here — and it seems the answer most likely lies in how Advancing Quality was implemented."

In the UK's program, Dr. McDonald said staff from all the participating hospitals met regularly face-to-face to resolve shared problems, which "seems to be key to its success."

The US on the other hand has opted for webinars to connect employees.

“All of this suggests that how these schemes are put into practice and the context in which they’re introduced can be crucial to patient outcomes," Dr. McDonald said. “These schemes can seem very simple on paper, but in practice they can be very difficult to implement successfully.”

The study, supported by the National Health Service National Institute for Health Research, was published online November 8 in the New England Journal of Medicine.

Reviewed by: 
Review Date: 
November 16, 2012
Last Updated:
November 26, 2012