>> Priv.-Doz. Dr. med. Lutz Fritsche from the Paul Gerhardt Diakonie started with his lecture “Hospital perspective: quality orientation and remuneration - expectations and reality”. The managing director of ten hospitals made it clear right from the start that “there is no area in which so much stupid stuff is said as in the quality debate”. In order to avoid this, it is important to clarify the terms of performance, to promote that of “Pay for Performance”, which correctly translated into German can mean “implementation” on the one hand, and “performance” on the other, which in English is again summarized in two terms: in Pay for Process and Pay for Outcome. For hospitals, this basic decision, which is what we are actually talking about, is very important: “Let’s talk about pay for performance, that is, about the possibility of getting more money if we do something better or do it the same way as the person who has the money. Would you like it?” Or, says Fritsche, would it be about starting a discount campaign? “From my experience, I have to tell you that many of the requests that I have experienced so far have primarily been about getting discounts,” explained Fritsche: “Simply doing what you have already done, a little cheaper.”
Fritsche therefore calls for more honesty in the discussion: “Is it more about punishing the hospitals that are not so good?” Or: “Do we want to help those that are actually all relatively bad to get better?” Once this fundamental distinction is made, it would be worth discussing whether the pay-for-performance approach could be effective here. The most recent Cochrane review on the benefits of pay for performance shows that pay for process is usually helpful because it has a positive impact on allocations. However, only the Americans would like that; in Germany, hospitals are immediately accused of admitting too many patients.
And with Pay for Performance, prescription costs could be influenced. Fritsche: “We know that from the German private practice sector and that it works.” But there is no evidence at all that Pay for Performance can be used to systematically get doctors to behave more in line with guidelines than they already do. For him, the central sentence of this Cochrane review is that there is no evidence that financial incentives in any way improve patient outcomes, i.e. the quality of results. Fritsche: “I could actually stop my lecture now.”
But what would happen, Fritsche continues to ponder, if this supposed evidence existed? If one day science would provide information about whether behavior actually changes when financial incentives are provided by changing fees or remuneration. Frische: “It doesn’t have to be about money, because doctors are very strongly influenced by public reputation.” Public reporting is a much more important incentive for doctors than a few euros more, which has definitely been studied and also corresponds to his perception. Although it
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