Cochrane · systematic review · CD011865
Payment methods for healthcare providers working in outpatient healthcare settings
Jia, L, Meng, Q, Scott, A, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
Effective Practice and Organisation of CareAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
28
current version
GRADE rated
19
No studies
9
Included studies
NR
No studies 9 · 32.1%Ungraded 0 · 0%Very low 11 · 39.3%Low 6 · 21.4%Moderate 2 · 7.1%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Pay for performance (P4P) plus existing payment methods compared with existing payment methods for outpatient healthcare providers
Population: healthcare providers working in outpatient healthcare settings
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Quantity of service provision (dichotomous) ‐ child immunisation status up‐to‐date Pay for performance (P4P) plus existing payment methods vs existing payment methods | RR 1.27 [1.19, 1.36] | 2 studies · 3760 participants | Moderate Downgraded: risk of bias |
Quantity of service provision (continuous) ‐ immunisation rates for patients aged 65 years or older Pay for performance (P4P) plus existing payment methods vs existing payment methods | MD 0.34 | 1 study · 54 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Quantity of service provision (continuous) ‐ number of detailed disease‐related consultation services per 100 prescriptions Pay for performance (P4P) plus existing payment methods vs existing payment methods | MD 1.24 [0.93, 1.54] | 1 study · 200 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Quality of service provision ‐ physician prescribing practices Pay for performance (P4P) plus existing payment methods vs existing payment methods | RR 1.07 [1.02, 1.12] | 1 study · 362 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Patient outcomes ‐ reduction in blood pressure Pay for performance (P4P) plus existing payment methods vs existing payment methods | MD 0.07 | 1 study · 181 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Quality of service provision and patient outcomes ‐ blood pressure management Pay for performance (P4P) plus existing payment methods vs existing payment methods | RR 1.13 [1.04, 1.23] | 1 study · 362 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Healthcare provider outcomes (such as work morale or workload) Pay for performance (P4P) plus existing payment methods vs existing payment methods | no estimate extracted | NR | No studies |
Costs Pay for performance (P4P) plus existing payment methods vs existing payment methods | no estimate extracted | 1 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Unintended or adverse effects Pay for performance (P4P) plus existing payment methods vs existing payment methods | RR 0.77 [0.71, 0.82] | 1 study · 362 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Fee‐for‐service (FFS) compared with existing payment methods for outpatient healthcare providers
Population: healthcare providers working in outpatient healthcare settings
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Quantity of service provision ‐ number of outpatients visits, specialist visits, or hospitalisations Fee‐for‐service (FFS) vs existing payment methods | no estimate extracted | 3 studies · 3 participants | Very low Downgraded: risk of bias, imprecision |
Quality of service provision Fee‐for‐service (FFS) vs existing payment methods | no estimate extracted | NR | No studies |
Patient outcomes ‐ people with mental illness Fee‐for‐service (FFS) vs existing payment methods | no estimate extracted | 1 study · 1 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Healthcare provider outcomes (such as work morale or workload) Fee‐for‐service (FFS) vs existing payment methods | no estimate extracted | NR | No studies |
Costs Fee‐for‐service (FFS) vs existing payment methods | no estimate extracted | 2 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Unintended or adverse effects Fee‐for‐service (FFS) vs existing payment methods | no estimate extracted | 1 study · 1 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Fee‐for‐service (FFS) mixed with existing payment methods compared with existing payment method for outpatient healthcare providers
Population: healthcare providers working in outpatient healthcare settings
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Quantity of service provision ‐ proportion of women/children receiving treatment Fee‐for‐service (FFS) mixed with existing payment methods vs existing payment method | no estimate extracted | 2 studies · 2 participants | Low Downgraded: risk of bias, imprecision |
Quality of service provision Fee‐for‐service (FFS) mixed with existing payment methods vs existing payment method | no estimate extracted | 1 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Patient outcomes ‐ satisfaction with care Fee‐for‐service (FFS) mixed with existing payment methods vs existing payment method | no estimate extracted | 1 study · 1 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Healthcare provider outcomes ‐ working hours and income Fee‐for‐service (FFS) mixed with existing payment methods vs existing payment method | no estimate extracted | 2 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Costs Fee‐for‐service (FFS) mixed with existing payment methods vs existing payment method | no estimate extracted | NR | No studies |
Unintended or adverse effects Fee‐for‐service (FFS) mixed with existing payment methods vs existing payment method | no estimate extracted | NR | No studies |
Enhanced fee‐for‐service (FFS) compared with FFS for outpatient healthcare providers
Population: healthcare providers working in outpatient healthcare settings
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Quantity of service provision ‐ child immunisation status up‐to‐date Enhanced fee‐for‐service (FFS) vs FFS | RR 1.25 [1.06, 1.48] | 2 studies · 2 participants | Moderate Downgraded: risk of bias |
Quantity of service provision ‐ primary healthcare visits by children Enhanced fee‐for‐service (FFS) vs FFS | no estimate extracted | 1 study · 1 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Quality of service provision Enhanced fee‐for‐service (FFS) vs FFS | no estimate extracted | NR | No studies |
Patient outcomes Enhanced fee‐for‐service (FFS) vs FFS | no estimate extracted | NR | No studies |
Healthcare provider outcomes (such as work morale or workload) Enhanced fee‐for‐service (FFS) vs FFS | no estimate extracted | NR | No studies |
Costs Enhanced fee‐for‐service (FFS) vs FFS | no estimate extracted | 1 study · 1 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Unintended or adverse effects Enhanced fee‐for‐service (FFS) vs FFS | no estimate extracted | NR | No studies |