At the surface it would seem a good idea. One pays your doctor only if you get better. Simple right?
It’s actually very complex.
Some of the difficulties include
– some conditions are difficult to measure in terms of “performance”
– some conditions are not “fixable” and treatment e.g. advanced cancer, is essentially palliative
– providers may avoid or neglect complex and difficult cases/conditions were the risk/benefit ratio makes it not worth the while
– providers may not want to take on non-compliant patients or chronic defaulters who will adversely affect their performance
– it requires a huge amount of data to collect and analyse which in turn requires a very strong IT infrastructure
– it requires a culture of transparency
In Malaysia, the dichotomous healthcare system makes it even more challenging. Shouldn’t a Pay for Performance system also apply to public as well as private hospitals? Don’t forget that Public healthcare is not really free or cheap. Tax payers are funding it and we would expect accountability in terms of performance in public hospitals too. An inefficient or under-performing public hospital by right should also be be held accountable in a truly transparent manner to the tax paying citizens who are funding the public hospital. But should their funding be cut – instead it may need to be increased to address areas of weakness?
All this is food for thought.
I have started a new discussion thread in the Malaysian doctors forum, Dobbs, on this issue. Doctors can follow it here.
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