The Impact of a Pay‐for‐Performance Scheme on Prescription Quality in Rural China
研究在中国农村乡镇卫生院比较了按人头总额预算与混合按绩效付费两种支付方式对处方质量和费用的影响，发现混合支付能减少不合理用药，但仅对初始绩效较好的县有效。
In this prospective study, conducted in China where providers have traditionally been paid fee-for-service, and where drug spending is high and irrational drug prescribing common, township health centers in two counties were assigned to two groups: in one fee-for-service was replaced by a capitated global budget (CGB); in the other by a mix of CGB and pay-for-performance. In the latter, 20% of the CGB was withheld each quarter, with the amount returned depending on points deducted for failure to meet performance targets. Outcomes studied included indicators of rational drug prescribing and prescription cost. Impacts were assessed using differences-in-differences, because political interference led to non-random assignment across the two groups. The combination of capitated global budget and pay-for-performance reduced irrational prescribing substantially relative to capitated global budget but only in the county that started above the penalty targets. Endline rates were still appreciable, however, and no effects were found in either county on out-of-pocket spending. Copyright © 2016 John Wiley & Sons, Ltd.