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Are bonuses the key to improving the quality of patient care? A recent study seems to think so...

By Anonymous on Aug 23, 2012

A US teen drug treatment study indicates that monetary incentives for healthcare professionals to provide long-term, sustained care could improve patient outcomes.

Recently, researchers from Chestnut Health Systems in Illinois assessed whether pay-for-performance bonuses based on the quality and quantity of care was an effective way to treat patients. This study involved 986 teenage patients who used marijuana or alcohol, 29 community-based treatment organisations and 105 therapists.  Each community organisation was to implement an evidence-based teen behavioural treatment programme either with or without financial incentives for the therapists over a few months.

This programme which offered standardised levels of training, coaching and funding involved patient discussions on social life, meeting specific goals and assessments of personal happiness. Thus, the programme focused on delivering a holistic form of treatment for the patient that factored in all important aspects of the patients’ lives and not just their disease. Organisations in the pay-for-performance group received $50 for each month per patient who progressed due to the treatment and $200 for each patient who improved as a result of the number of treatment procedures and sessions.

Findings from the study demonstrated that therapists delivered better care to the patient when rewarded. 17% of Therapists who received bonuses gave their patients the full amount of recommended treatment as compared with less than 3% for those who did not receive any financial incentive. It is worrying that even with these bonuses on top of their salary only a minority of provided the recommended level of care for their patients. But, these were small incentives that led to better therapist performance indicating that if incentives were increased, more patients would benefit. However, due to the short-term nature of the study, it was not possible to measure whether the teenage patients were likely to stop using drugs or alcohol as a result of the treatment.

Although about 41% - 51% of the teenagers did not use drugs or alcohol for at least a month following their last session with a therapist, follow-up data was not available for half or two-thirds of these teenagers.

Is it appropriate for financial incentives to be used to encourage long-term care? Clare Gerada, chairwoman of the Royal College of Practitioners believes that instead of using incentives, which lose their value quickly, we should give health professionals the time, space and capacity to provide excellent, accessible, personal care for patients because it is the right thing to do. However, is today’s healthcare industry, which is faced with increasing costs and pressure, still motivated by what doing the right thing? While researchers from the University of Australia also found that financial incentives might undermine the motivation for doctors to provide better care for the patient, the possibility of implementing a bonus scheme should not be abandoned altogether. Any new incentive programme should include research to examine its impact, downside, cost-effectiveness and long-term impact.

Delivering a sustained holistic care programme will ensure that the patient is regularly empowered to take their treatment. Following on from this teen drug treatment study in Illinois, researchers should organise a long-term follow-up study to investigate whether the teenagers continued to adhere to the recommended treatment.

In addition, collaboration is key in delivering holistic healthcare for the patient. The pharmaceutical industry could help train, coach or fund healthcare professionals to deliver a fuller form of care for the patient that maintains the long-term quality of life for patient through improved drug treatment plans. Perhaps, initial clinical trials also need to have long-term follow ups to ensure long-term adherence. Thus, if pharma begins to focus on a long-term, holistic health service for patients, healthcare professionals are more likely to deliver this same level of care which will gradually improve patient outcomes in the future.