Dear Padhraig Thanks for this.There is always a great brisk that fiscal
austerity will increase the flow of faith based policy making from our
politicians. In England that is one way of disguising the expenditure
crunch Evidence free policy makers seem to agree that greater system
productivity can be easily acquired from reducing clinical practice
variations despite the fact we have measured them forbdecdes and made
little progress in altering them.The new faith is pay for performance.The
available evidence on P4P is less than convincing with jurisdictions
altering systems and failing to evaluate cost effectiveness. i have a paper
reviewing this in Health Economics next month "Fun" to see obamo hoping to
reap gains of P4P like the Irish and Brits.The nice issue this side of pond
is whether fisclabausterity itself and/or P4P will offer salvation as bank
induced stupidity shrinks GDP and GNP Best wishes AlanOn Dec 6 2011,
Padhraig Ryan wrote:
>Download at: http://ssrn.com/author=1225365
>P. Ryan (2011). Transforming Primary Care in Ireland:
>Information, Incentives, and Provider Capabilities. Trinity College
>Dublin, Centre for Health Policy and Management. Working Paper.
>
>Abstract:
>Ireland's health system is at a key turning point. The Irish
>government was newly elected in February 2011, and the policy
>directions adopted over the coming months will likely exert a major
>impact on system performance for many years. Drawing on recent
>international experience with performance measurement and financial
>incentives, this paper examines strategies for enhancing quality and
>value in the Irish health system, focusing predominantly on the role
>of primary care.
>
>Three take-home messages emerge from the literature. First,
>substantial improvements in quality of care often can be attained at a
>reasonable cost, such as through the use of checklists and
>evidence-based clinical pathways, or by better aligning the skills of
>health care providers to patients' need. Second, rigorous performance
>measurement is a vital tool for quality improvement that is lacking in
>Ireland, and this could be particularly powerful if underpinned by
>risk-adjustment to enable reliable evaluation of clinical outcomes.
>Pilot projects are required to examine the feasibility of these
>techniques in the Irish context. Third, although pay-for-performance
>is a prominent quality improvement strategy, little evidence exists to
>support its purported benefits and it can exert negative effects.
>Incentives are unlikely to be effective if providers lack the
>capability to respond appropriately, therefore it is imperative to
>foster professionalism and pride in high-quality care, and to develop
>the managerial and clinical skills necessary for high performance.
>
>Primary care, quality, efficiency, incentives, competition
>
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