Publications
53 results found
Yordanov D, Oxholm AS, Prætorius T, et al., 2024, Financial incentives for integrated care: A scoping review and lessons for evidence-based design., Health Policy, Vol: 141
BACKGROUND: In response to the increasing prevalence of people with chronic conditions, healthcare systems restructure to integrate care across providers. However, many systems fail to achieve the desired outcomes. One likely explanation is lack of financial incentives for integrating care. OBJECTIVES: We aim to identify financial incentives used to promote integrated care across different types of providers for patients with common chronic conditions and assess the evidence on (cost-)effectiveness and the facilitators/barriers to their implementation. METHODS: This scoping review identifies studies published before December 2021, and includes 33 studies from the United States and the Netherlands. RESULTS: We identify four types of financial incentives: shared savings, bundled payments, pay for performance, and pay for coordination. Substantial heterogeneity in the (cost-)effectiveness of these incentives exists. Key implementation barriers are a lack of infrastructure (e.g., electronic medical records, communication channels, and clinical guidelines). To facilitate integration, financial incentives should be easy to communicate and implement, and require additional financial support, IT support, training, and guidelines. CONCLUSIONS: All four types of financial incentives may promote integrated care but not in all contexts. Shared savings appears to be the most promising incentive type for promoting (cost-)effective care integration with the largest number of favourable studies allowing causal interpretations. The limited evidence pool makes it hard to draw firm conclusions that are transferable across contexts.
Kristensen SR, Anselmi L, Brown GW, et al., 2023, Pay for performance at a crossroads: lessons from taking a global perspective, International Journal of Public Sector Management, Vol: 36, Pages: 592-605, ISSN: 0951-3558
Purpose: The use of pay for performance (P4P) as an instrument to incentivise quality improvements in health care is at a crossroads in high-income countries but has remained a commonly used tool in low- and middle-income countries. The authors aimed to take stock of the evidence on effectiveness and design from across income settings to reveal insights for the future design of performance payment across income contexts. Design/methodology/approach: The authors identified Cochrane literature reviews of the use of P4P in health care in any income setting, tracked the development in the quantity and quality of evidence over time, and compared the incentive design features used across high-income countries compared to low- and middle-income countries. Findings: The quantity and quality of the evidence base have grown over time but can still be improved. Scheme design varies across income settings, and although some design choices may reflect differences in context, the authors find that incentive designers in both income settings can learn from practices used in the other setting. Originality/value: The research and literature on P4P in high-, low- and middle-income countries largely operate in silos. By taking stock of the evidence on P4P from across income settings, the authors are able to draw out key insights between these settings, which remain underexplored in the literature.
Greve J, Kristensen SR, Lydiksen N, 2023, Patient and peer: Guideline design and expert response., J Health Econ, Vol: 92
We examine how patients' medical expertise influences adherence to clinical guidelines for a treatment that is common, costly, and rationed by the clinical guidelines. Using administrative data on prenatal diagnostic testing (PDT), we compare the testing rates of medically trained patients (experts) and non-medically trained patients (non-experts) on the margin of eligibility thresholds in clinical guidelines. We find that experts are 9 percentage points more likely to receive PDT than non-experts when they are not eligible for testing and that more than 80% of the difference can be attributed to medical expertise. Our results suggest that the design of clinical guidelines is important for adherence and that having medical expertise as a patient affects treatment, when there is room for a deviation from the guideline.
Feng Y, Kristensen SR, Lorgelly P, et al., 2023, Pay-for-Performance incentives for specialised services in England: a mixed methods evaluation, EUROPEAN JOURNAL OF HEALTH ECONOMICS, ISSN: 1618-7598
Tsiachristas A, Vrangbaek K, Gongora-Salazar P, et al., 2023, Integrated care in a Beveridge system: experiences from England and Denmark, HEALTH ECONOMICS POLICY AND LAW, Vol: 18, Pages: 345-361, ISSN: 1744-1331
Wallenburg I, Friebel R, Henschke C, et al., 2023, Special issue: On the roof top of health policy change: overlooking 21 years of the European Health Policy Group, HEALTH ECONOMICS POLICY AND LAW, Vol: 18, Pages: 342-344, ISSN: 1744-1331
Lugo-Palacios DG, Clarke JM, Kristensen SR, 2023, Back to basics: A mediation analysis approach to addressing the fundamental questions of integrated care evaluations, HEALTH ECONOMICS, Vol: 32, Pages: 2080-2097, ISSN: 1057-9230
Britteon P, Kristensen SR, Lau Y-S, et al., 2023, Spillover effects of financial incentives for providers onto non-targeted patients: daycase surgery in English hospitals., Health Econ Policy Law, Vol: 18, Pages: 289-304
BACKGROUND: Incentives for healthcare providers may also affect non-targeted patients. These spillover effects have important implications for the full impact and evaluation of incentive schemes. However, there are few studies on the extent of such spillovers in health care. We investigated whether incentives to perform surgical procedures as daycases affected whether other elective procedures in the same specialties were also treated as daycases. DATA: 8,505,754 patients treated for 92 non-targeted procedures in 127 hospital trusts in England between April and March 2016. METHODS: Interrupted time series analysis of the probability of being treated as a daycase for non-targeted patients treated in six specialties where targeted patients were also treated and three specialties where they were not. RESULTS: The daycase rate initially increased (1.04 percentage points, SE: 0.30) for patients undergoing a non-targeted procedure in incentivised specialties but then reduced over time. Conversely, the daycase rate gradually decreased over time for patients treated in a non-incentivised specialty. DISCUSSION: Spillovers from financial incentives have variable effects over different activities and over time. Policymakers and researchers should consider the possibility of spillovers in the design and evaluation of incentive schemes.
Xiao M, Kristensen SR, Marti J, et al., 2023, The impact of patient safety incidents during hip and knee replacements on patients' health related quality of life: a before and after study using longitudinal data linked to patient-reported outcome measures, INTERNATIONAL JOURNAL OF SURGERY, Vol: 109, Pages: 1085-1093, ISSN: 1743-9191
Gurgel Junior GD, Kristensen SR, da Silva EN, et al., 2023, Pay-for-performance for primary health care in Brazil: A comparison with England?s Quality Outcomes Framework and lessons for the future, HEALTH POLICY, Vol: 128, Pages: 62-68, ISSN: 0168-8510
Fardousi N, Nunes da Silva E, Kovacs R, et al., 2022, Performance bonuses and the quality of primary health care delivered by family health teams in Brazil: A difference-in-differences analysis., PLoS Med, Vol: 19
BACKGROUND: Pay-for-performance (P4P) programmes to incentivise health providers to improve quality of care have been widely implemented globally. Despite intuitive appeal, evidence on the effectiveness of P4P is mixed, potentially due to differences in how schemes are designed. We exploited municipality variation in the design features of Brazil's National Programme for Improving Primary Care Access and Quality (PMAQ) to examine whether performance bonuses given to family health team workers were associated with changes in the quality of care and whether the size of bonus mattered. METHODS AND FINDINGS: For this quasi-experimental study, we used a difference-in-differences approach combined with matching. We compared changes over time in the quality of care delivered by family health teams between (bonus) municipalities that chose to use some or all of the PMAQ money to provide performance-related bonuses to team workers with (nonbonus) municipalities that invested the funds using traditional input-based budgets. The primary outcome was the PMAQ score, a quality of care index on a scale of 0 to 100, based on several hundred indicators (ranging from 598 to 660) of health care delivery. We did one-to-one matching of bonus municipalities to nonbonus municipalities based on baseline demographic and economic characteristics. On the matched sample, we used ordinary least squares regression to estimate the association of any bonus and size of bonus with the prepost change over time (between November 2011 and October 2015) in the PMAQ score. We performed subgroup analyses with respect to the local area income of the family health team. The matched analytical sample comprised 2,346 municipalities (1,173 nonbonus municipalities; 1,173 bonus municipalities), containing 10,275 family health teams that participated in PMAQ from the outset. Bonus municipalities were associated with a 4.6 (95% CI: 2.7 to 6.4; p < 0.001) percentage point increase in the PMAQ score compared with
Kovacs R, Brown GW, Kadungure A, et al., 2022, Who is paid in pay-for-performance? Inequalities in the distribution of financial bonuses amongst health centres in Zimbabwe, HEALTH POLICY AND PLANNING, Vol: 37, Pages: 429-439, ISSN: 0268-1080
Allen T, Gyrd-Hansen D, Kristensen SR, et al., 2022, Physicians under Pressure: Evidence from Antibiotics Prescribing in England, MEDICAL DECISION MAKING, Vol: 42, Pages: 303-312, ISSN: 0272-989X
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- Citations: 3
Francetic I, Meacock R, Elliott J, et al., 2022, Framework for identification and measurement of spillover effects in policy implementation: intended non-intended targeted non-targeted spillovers (INTENTS)., Implement Sci Commun, Vol: 3
BACKGROUND: There is increasing awareness among researchers and policymakers of the potential for healthcare interventions to have consequences beyond those initially intended. These unintended consequences or "spillover effects" result from the complex features of healthcare organisation and delivery and can either increase or decrease overall effectiveness. Their potential influence has important consequences for the design and evaluation of implementation strategies and for decision-making. However, consideration of spillovers remains partial and unsystematic. We develop a comprehensive framework for the identification and measurement of spillover effects resulting from changes to the way in which healthcare services are organised and delivered. METHODS: We conducted a scoping review to map the existing literature on spillover effects in health and healthcare interventions and used the findings of this review to develop a comprehensive framework to identify and measure spillover effects. RESULTS: The scoping review identified a wide range of different spillover effects, either experienced by agents not intentionally targeted by an intervention or representing unintended effects for targeted agents. Our scoping review revealed that spillover effects tend to be discussed in papers only when they are found to be statistically significant or might account for unexpected findings, rather than as a pre-specified feature of evaluation studies. This hinders the ability to assess all potential implications of a given policy or intervention. We propose a taxonomy of spillover effects, classified based on the outcome and the unit experiencing the effect: within-unit, between-unit, and diagonal spillover effects. We then present the INTENTS framework: Intended Non-intended TargEted Non-Targeted Spillovers. The INTENTS framework considers the units and outcomes which may be affected by an intervention and the mechanisms by which spillover effects are generated. CONC
Clarke L, Anderson M, Anderson R, et al., 2021, Economic Aspects of Delivering Primary Care Services: An Evidence Synthesis to Inform Policy and Research Priorities, MILBANK QUARTERLY, Vol: 99, Pages: 974-1023, ISSN: 0887-378X
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- Citations: 2
Lydiksen N, Greve J, Jakobsen M, et al., 2021, Using national clinical guidelines to reduce practice variation-the case of Denmark, HEALTH POLICY, Vol: 125, Pages: 793-798, ISSN: 0168-8510
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- Citations: 2
Hayes H, Stokes J, Kristensen SR, et al., 2021, The effect of payment method and multimorbidity on health and healthcare utilisation, JOURNAL OF HEALTH ORGANIZATION AND MANAGEMENT, Vol: 35, Pages: 382-405, ISSN: 1477-7266
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- Citations: 1
Stokes J, Shah V, Goldzahl L, et al., 2021, Does prevention-focused integration lead to the triple aim? An evaluation of two new care models in England, JOURNAL OF HEALTH SERVICES RESEARCH & POLICY, Vol: 26, Pages: 125-132, ISSN: 1355-8196
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- Citations: 7
Kovacs R, Maia Barreto JO, da Silva EN, et al., 2021, Socioeconomic inequalities in the quality of primary care under Brazil's national pay-for-performance programme: a longitudinal study of family health teams, LANCET GLOBAL HEALTH, Vol: 9, Pages: E331-E339, ISSN: 2214-109X
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- Citations: 12
Singh NS, Kovacs RJ, Cassidy R, et al., 2021, A realist review to assess for whom, under what conditions and how pay for performance programmes work in low- and middle-income countries, SOCIAL SCIENCE & MEDICINE, Vol: 270, ISSN: 0277-9536
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- Citations: 21
Kristensen SR, Olsen KR, 2021, Sustainable health care and health care reforms in denmark 2000–2020, Contributions to Economic Analysis, Pages: 103-116
In this chapter, we focus on the major reforms intended to ensure the sustainability of health care in Denmark between 2000 and 2020 and the evidence for the effectiveness of these reforms. We take a broad definition of sustainability and include reforms that aimed to improve the productivity of the health care sector both in terms of increasing activity for the same set of inputs and in terms of improving the quality of care. A characterisation of the Danish health care system as having gone through evolution rather than revolution (Pedersen, Christiansen, & Bech, 2005) is, with one exception, still true today, and reforms have been relatively few. As we demonstrate there is a relative lack of formal evaluations of these reforms. In the first decade of the period, the majority of new policy measures aimed to increase the quantity of care provided by the health care sector. With the introduction of diagnosis-related groups (DRGs) to measure hospital activity, a wave of reforms created a stronger link between activity and hospital reimbursement, and introduced additional incentives for increasing activity, alongside requirements for increased technical efficiency. A centralisation reform in 2007 reduced the number of administrative units and saw the beginning of a development that would also lead to fewer hospital units. Procurements of medicines were professionalised, and a national council was established to consider the use of expensive hospital medicine. In the second-half of the period, policy makers began questioning whether increased activity was always for the better, and slowly began experimenting with initiatives that would shift the focus to the quality and appropriateness of care. As in many other countries, this move occurred in the light of a realisation of a shift in the demographic structure of the country and the change this was expected to create for the future demand for health care. Although some empirical evidence exists, it is striking that
Simonsen NF, Oxholm AS, Kristensen SR, et al., 2020, What explains differences in waiting times for health care across socioeconomic status?, HEALTH ECONOMICS, Vol: 29, Pages: 1764-1785, ISSN: 1057-9230
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- Citations: 7
Anselmi L, Borghi J, Brown GW, et al., 2020, Pay for Performance: A Reflection on How a Global Perspective Could Enhance Policy and Research, INTERNATIONAL JOURNAL OF HEALTH POLICY AND MANAGEMENT, Vol: 9, Pages: 365-369
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- Citations: 7
Kovacs RJ, Powell-Jackson T, Kristensen SR, et al., 2020, How are pay-for-performance schemes in healthcare designed in low- and middle-income countries? Typology and systematic literature review, BMC HEALTH SERVICES RESEARCH, Vol: 20
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- Citations: 21
Feng Y, Kristensen SR, Lorgelly P, et al., 2019, Pay for performance for specialised care in England: Strengths and weaknesses, HEALTH POLICY, Vol: 123, Pages: 1036-1041, ISSN: 0168-8510
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- Citations: 7
Ghafur S, Kristensen S, honeyford K, et al., 2019, A retrospective impact analysis of the WannaCry cyber-attack on the NHS, npj Digital Medicine, Vol: 2, ISSN: 2398-6352
A systematic analysis of Hospital Episodes Statistics (HES) data was done to determine the effects of the 2017 WannaCry attack on the National Health Service (NHS) by identifying the missed appointments, deaths, and fiscal costs attributable to the ransomware attack. The main outcomes measured were: outpatient appointments cancelled, elective and emergency admissions to hospitals, Accident & Emergency (A&E) attendances, and deaths in A&E. Compared with the baseline, there was no significant difference in the total activity across all trusts during the week of the WannaCry attack. Trusts had 1% more emergency admissions and 1% fewer A&E attendances per day during the WannaCry week compared with baseline. Hospitals directly infected with the ransomware, however, had significantly fewer emergency and elective admissions: a decrease of about 6% in total admissions per infected hospital per day was observed, with 4% fewer emergency admissions and 9% fewer elective admissions. No difference in mortality was noted. The total economic value of the lower activity at the infected trusts during this time was £5.9m including £4m in lost inpatient admissions, £0.6m from lost A&E activity, and £1.3m from cancelled outpatient appointments. Among hospitals infected with WannaCry ransomware, there was a significant decrease in the number of attendances and admissions, which corresponded to £5.9m in lost hospital activity. There was no increase in mortality reported, though this is a crude measure of patient harm. Further work is needed to appreciate the impact of a a cyber attack or IT failure on care delivery and patient safety.
Stokes J, Lau Y-S, Kristensen SR, et al., 2019, Does pooling health & social care budgets reduce hospital use and lower costs? (vol 232, pg 382, 2019), SOCIAL SCIENCE & MEDICINE, Vol: 235, ISSN: 0277-9536
Meacock R, Anselmi L, Kristensen SR, et al., 2019, Do variations in hospital admission rates bias comparisons of standardized hospital mortality rates? A population-based cohort study, SOCIAL SCIENCE & MEDICINE, Vol: 235, ISSN: 0277-9536
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- Citations: 2
Stokes J, Lau Y-S, Kristensen SR, et al., 2019, Does pooling health & social care budgets reduce hospital use and lower costs?, SOCIAL SCIENCE & MEDICINE, Vol: 232, Pages: 382-388, ISSN: 0277-9536
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- Citations: 14
Kluge H, Kelley E, Swaminathan S, et al., 2018, After Astana: building the economic case for increased investment in primary health care., Lancet, Vol: 392, Pages: 2147-2152
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