The impact of reimbursement systems on equity in access and quality of primary care: A systematic literature review

BMC Health Services Research

Volumn 16, Issue 1, 2016, Pages 1-10

  Tao, Wenjing ^a,b   Agerholm, Janne ^a,b   Burström, Bo ^a,b  

^a STOCKHOLM COUNTY COUNCIL   (Sweden)

^b KAROLINSKA INSTITUTE   (Sweden)

Author keywords

Capitation fee; Ethnic groups; Health policy; Health services accessibility; Healthcare disparities; Inequality; Outcome assessment; Quality of health care; Reimbursement mechanisms; Socioeconomic factors

Indexed keywords

AMBULATORY CARE; ECONOMICS; HEALTH CARE DELIVERY; HEALTH CARE DISPARITY; HEALTH EQUITY; HOSPITALIZATION; HUMAN; MEDICAL FEE; OUTCOME ASSESSMENT; PATIENT SATISFACTION; PRIMARY HEALTH CARE; REIMBURSEMENT; STANDARDS; UNITED KINGDOM; UNITED STATES;

AMBULATORY CARE; FEE-FOR-SERVICE PLANS; HEALTH EQUITY; HEALTH SERVICES ACCESSIBILITY; HEALTHCARE DISPARITIES; HOSPITALIZATION; HUMANS; OUTCOME ASSESSMENT (HEALTH CARE); PATIENT SATISFACTION; PRIMARY HEALTH CARE; REIMBURSEMENT, INCENTIVE; UNITED KINGDOM; UNITED STATES;

EID: 84990854108     PISSN: None     EISSN: 14726963     Source Type: Journal    
DOI: 10.1186/s12913-016-1805-8     Document Type: Article

References (54)

1. Marmot M. Social determinants of health inequalities. Lancet. 2005;365(9464):1099-104.
2. Mackenbach JP, Stirbu I, Roskam AJ, Schaap MM, Menvielle G, Leinsalu M, Kunst AE, European Union Working Group on Socioeconomic Inequalities in H. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008;358(23):2468-81.
3. Mensah GA, Mokdad AH, Ford ES, Greenlund KJ, Croft JB. State of disparities in cardiovascular health in the United States. Circulation. 2005;111(10):1233-41.
4. Balarajan R. Ethnic differences in mortality from ischaemic heart disease and cerebrovascular disease in England and Wales. BMJ. 1991;302(6776):560-4.
5. Chaturvedi N, McKeigue PM, Marmot MG. Resting and ambulatory blood pressure differences in Afro-Caribbeans and Europeans. Hypertension. 1993;22(1):90-6.
6. Burstrom B. Market-oriented, demand-driven health care reforms and equity in health and health care utilization in Sweden. Int J Health Serv. 2009;39(2):271-85.
7. Porell FW. A comparison of ambulatory care-sensitive hospital discharge rates for Medicaid HMO enrollees and nonenrollees. Med Care Res Rev. 2001;58(4):404-24. discussion 425-409.
8. Asch SM, Kerr EA, Keesey J, Adams JL, Setodji CM, Malik S, McGlynn EA. Who is at greatest risk for receiving poor-quality health care? N Engl J Med. 2006;354(11):1147-56.
9. Bindman AB, Chattopadhyay A, Osmond DH, Huen W, Bacchetti P. The impact of Medicaid managed care on hospitalizations for ambulatory care sensitive conditions. Health Serv Res. 2005;40(1):19-38.
10. Le Cook B. Effect of Medicaid Managed Care on racial disparities in health care access. Health Serv Res. 2007;42(1):124-45.
11. Agerholm J, Bruce D, Ponce de Leon A, Burstrom B. Socioeconomic differences in healthcare utilization, with and without adjustment for need: an example from Stockholm, Sweden. Scand J Public Health. 2013;41(3):318-25.
12. Zackrisson S, Andersson I, Manjer J, Janzon L. Non-attendance in breast cancer screening is associated with unfavourable socio-economic circumstances and advanced carcinoma. Int J Cancer. 2004;108(5):754-60.
13. Nolte E, McKee M. Measuring the health of nations: analysis of mortality amenable to health care. BMJ. 2003;327(7424):1129.
14. Shi L, Starfield B, Politzer R, Regan J. Primary care, self-rated health, and reductions in social disparities in health. Health Serv Res. 2002;37(3):529-50.
15. Simoens S, Giuffrida A. The impact of physician payment methods on raising the efficiency of the healthcare system: an international comparison. Appl Health Econ Health Policy. 2004;3(1):39-46.
16. Aas IH. Incentives and financing methods. Health Policy. 1995;34(3):205-20.
17. Jegers M, Kesteloot K, De Graeve D, Gilles W. A typology for provider payment systems in health care. Health Policy. 2002;60(3):255-73.
18. Sundquist K, Malmstrom M, Johansson SE, Sundquist J. Care Need Index, a useful tool for the distribution of primary health care resources. J Epidemiol Community Health. 2003;57(5):347-52.
19. Alshamsan R, Majeed A, Ashworth M, Car J, Millett C. Impact of pay for performance on inequalities in health care: systematic review. J Health Serv Res Policy. 2010;15(3):178-84.
20. Koshy E, Millett C. The 'Quality and Outcomes Framework': improving care, but are all patients benefiting? J R Soc Med. 2008;101(9):432-3.
21. Marmot M, Friel S, Bell R, Houweling TA, Taylor S, Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008;372(9650):1661-9.
22. Whitehead M, Dahlgren G. Concepts and principles for tackling social inequities in health: Levelling up, part 2. Geneva, Switzerland: World Health Organization; 2007.
23. Petticrew M. Systematic reviews in the social sciences: a practical guide. Oxford, UK: Blackwell Publishing; 2005.
24. Zaza S, Wright-De Aguero LK, Briss PA, Truman BI, Hopkins DP, Hennessy MH, Sosin DM, Anderson L, Carande-Kulis VG, Teutsch SM, et al. Data collection instrument and procedure for systematic reviews in the Guide to Community Preventive Services. Task Force on Community Preventive Services. Am J Prev Med. 2000;18(1 Suppl):44-74.
25. Centre for Occupational and Environmental Health. Critical Appraisal. University of Manchester. Manchester: School of Epidemiology and Health Sciences; 2003. http://research.bmh.manchester.ac.uk/epidemiology/COEH/undergraduate/specialstudymodules/criticalappraisal/. Accessed 30 Sept 2016.
26. Sanderson S, Tatt ID, Higgins JP. Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography. Int J Epidemiol. 2007;36(3):666-76.
27. Gough D, Thomas J, Oliver S. Clarifying differences between review designs and methods. Syst Rev. 2012;1:28.
28. Millett C, Bottle A, Ng A, Curcin V, Molokhia M, Saxena S, Majeed A. Pay for performance and the quality of diabetes management in individuals with and without co-morbid medical conditions. J R Soc Med. 2009;102(9):369-77.
29. Murray J, Saxena S, Millett C, Curcin V, de Lusignan S, Majeed A. Reductions in risk factors for secondary prevention of coronary heart disease by ethnic group in south-west London: 10-year longitudinal study (1998-2007). Fam Pract. 2010;27(4):430-8.
30. Stepanikova I, Cook KS. Insurance policies and perceived quality of primary care among privately insured patients - Do features of managed care widen the racial, ethnic, and language-based gaps? Med Care. 2004;42(10):966-74.
31. Balsa AI, Cao Z, McGuire TG. Does managed health care reduce health care disparities between minorities and Whites? J Health Econ. 2007;26(1):101-21.
32. Muggah E, Dahrouge S, Hogg W. Access to primary health care for immigrants: results of a patient survey conducted in 137 primary care practices in Ontario, Canada. BMC Fam Pract. 2012;13:128.
33. Bindman AB, Grumbach K, Osmond D, Komaromy M, Vranizan K, Lurie N, Billings J, Stewart A. Preventable hospitalizations and access to health care. JAMA. 1995;274(4):305-11.
34. Department of Health. The NHS Improvement Plan: Putting People at the Heart of Public Services. London: DH Publications; 2004.
35. Alshamsan R, Lee JT, Majeed A, Netuveli G, Millett C. Effect of a UK pay-for-performance program on ethnic disparities in diabetes outcomes: interrupted time series analysis. Ann Fam Med. 2012;10(3):228-34.
36. Millett C, Gray J, Saxena S, Netuveli G, Khunti K, Majeed A. Ethnic disparities in diabetes management and pay-for-performance in the UK: the Wandsworth Prospective Diabetes Study. PLoS Med. 2007;4(6):e191.
37. McGovern MP, Williams DJ, Hannaford PC, Taylor MW, Lefevre KE, Boroujerdi MA, Simpson CR. Introduction of a new incentive and target-based contract for family physicians in the UK: good for older patients with diabetes but less good for women? Diabet Med. 2008;25(9):1083-9.
38. Hamilton FL, Bottle A, Vamos EP, Curcin V, Anthea, Molokhia M, Majeed A, Millett C. Impact of a pay-for-performance incentive scheme on age, sex, and socioeconomic disparities in diabetes management in UK primary care. J Ambul Care Manage. 2010;33(4):336-49.
39. Kontopantelis E, Reeves D, Valderas JM, Campbell S, Doran T. Recorded quality of primary care for patients with diabetes in England before and after the introduction of a financial incentive scheme: a longitudinal observational study. BMJ Qual Saf. 2013;22(1):53-64.
40. Crawley D, Ng A, Mainous 3rd AG, Majeed A, Millett C. Impact of pay for performance on quality of chronic disease management by social class group in England. J R Soc Med. 2009;102(3):103-7.
41. Millett C, Gray J, Wall M, Majeed A. Ethnic disparities in coronary heart disease management and pay for performance in the UK. J Gen Intern Med. 2009;24(1):8-13.
42. McGovern MP, Boroujerdi MA, Taylor MW, Williams DJ, Hannaford PC, Lefevre KE, Simpson CR. The effect of the UK incentive-based contract on the management of patients with coronary heart disease in primary care. Fam Pract. 2008;25(1):33-9.
43. Simpson CR, Hannaford PC, Ritchie LD, Sheikh A, Williams D. Impact of the pay-for-performance contract and the management of hypertension in Scottish primary care: a 6-year population-based repeated cross-sectional study. Br J Gen Pract. 2011;61(588):e443-451.
44. Simpson CR, Hannaford PC, Lefevre K, Williams D. Effect of the UK incentive-based contract on the management of patients with stroke in primary care. Stroke. 2006;37(9):2354-60.
45. Hammouche S, Holland R, Steel N. Does quality of care for hypertension in primary care vary with postcode area deprivation? An observational study. BMC Health Serv Res. 2011;11:297.
46. Lee JT, Netuveli G, Majeed A, Millett C. The effects of pay for performance on disparities in stroke, hypertension, and coronary heart disease management: interrupted time series study. PLoS One. 2011;6(12):e27236.
47. Smith CJP, Gribbin J, Challen KB, Hubbard RB. The impact of the 2004 NICE guideline and 2003 General Medical Services contract on COPD in primary care in the UK. Qjm-an Int J Med. 2008;101(2):145-53.
48. Bhalla R, Schechter CB, Strelnick AH, Deb N, Meissner P, Currie BP. Pay for performance improves quality across demographic groups. Qual Manag Health Care. 2013;22(3):199-209.
49. Dowd B, Maciejewski ML, O'Connor H, Riley G, Geng Y. Health plan enrollment and mortality in the Medicare program. Health Econ. 2011;20(6):645-59.
50. Norbury M, Fawkes N, Guthrie B. Impact of the GP contract on inequalities associated with influenza immunisation: a retrospective population-database analysis. Br J Gen Pract. 2011;61(588):e379-385.
51. Millett C, Gray J, Saxena S, Netuveli G, Majeed A. Impact of a pay-for-performance incentive on support for smoking cessation and on smoking prevalence among people with diabetes. CMAJ. 2007;176(12):1705-10.
52. Taggar JS, Coleman T, Lewis S, Szatkowski L. The impact of the Quality and Outcomes Framework (QOF) on the recording of smoking targets in primary care medical records: cross-sectional analyses from The Health Improvement Network (THIN) database. BMC Public Health. 2012;12:329.
53. Culyer AJ. Equity - some theory and its policy implications. J Med Ethics. 2001;27(4):275-83.
54. Barr B, Bambra C, Whitehead M. The impact of NHS resource allocation policy on health inequalities in England 2001-11: longitudinal ecological study. BMJ. 2014;348:g3231.