Pay-for-Performance May Exacerbate Inequalities

Although overall performance for heart attack and heart failure improved across the study, quality at hospitals in disadvantaged regions continued to “lag significantly behind” better-advantaged peer institutions. The researchers determined that these facilities would receive reduced reimbursement under a pay-for-performance system. Noting that nearly 33% of the hospitals studied were in “locationally disadvantaged” counties, the researchers warn that a pay-for-performance model may “exacerbate inequalities” across regions by rewarding hospitals located in regions that are rich in economic and human resources, and punishing facilities that are in disadvantaged locations.

Full article on pay-for-performance reimbursement plans for hospitals.

Comments (6)

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  1. Virginia says:

    Darn those inequalities. If only we could find a way to make everyone the same and deliver the same quality of care in every single city!

    Or, we could trust the free market to do it’s business and stop trying to create all sorts of funky payment systems that get more and more complicated by the day.

  2. Ken says:

    It’s not the inequalities that are the problem, Virginia. It’s the bungling bureaucracy.

  3. Greg says:

    This is one more nail in the coffin of pay for performance.

  4. Virginia says:

    I think we’ll see inequalities in any system. The question is how much effort do we want to put in preventing them? But, I agree. It’s the bureaucracy that makes it worse.

    I personally am not sure that equality is the goal we want to shoot for. We’re probably better off trying to improve quality of care across the board and only looking at differences in care as ways of improving underperforming hospitals. We’ll never have everyone receiving the same care.

  5. Devon Herrick says:

    This report insinuates holding hospitals in disadvantaged regions accountable may harm (presumably disadvantaged) patients, who might be adversely effected when these low-performing hospitals get lower reimbursements.

    But aren’t disadvantaged patients already being harmed by being forced to seek care in low-performing hospitals?

  6. Jeet says:

    As a geenral rule, I think it is good. What a psychologist can help with are things that family and friends cannot or will not deal with. A combat veteran can’t talk to his family about some of the things he has seen and done, or shouldn’t. Most people have no such serious problems. Family and friends should be who most people turn to. And if they don’t have these resources, psychology can’t help them.Beyond psychology and psychiatry being illiberal, they have shot themselves in the foot in too many other ways. They hide diagnosis and do things behind “client’s” backs, they don’t make sure there isn’t a medical reason for the problems, they push drugs often unnecessarily. And they have been noted for using terrible “treatments”, such as electric shock, lobotomies, hot and cold baths. Reprehensible. But more, their work seldom leads to relief, real long term alterations toward a more functional life.I am sure there are therapists out there who are very good. I simply haven’t met one. Twits and power hungry nobodies messing with other people’s lives because they have no understanding, or moral reality, in their own lives. Much like doctors, they are in it for the money. Unlike doctors, they aren’t even as good at producing a better outcome. It is time to nearly bury the “profession”.I, personally, am now of the opinion that psychology is a thing of socialism, and therefore cannot be saved. It is unscientific, impractical, expensive, and doesn’t work. No offense but you did ask.