The Impact of Physician Bonuses, Enhanced Fees, and Feedback on Childhood Immunization Coverage Rates

Department of Epidemiology and Social Medicine, Bronx, NY 10467, USA.
American Journal of Public Health (Impact Factor: 4.55). 02/1999; 89(2):171-5. DOI: 10.2105/AJPH.89.2.171
Source: PubMed


The purpose of this study was to examine the effects on immunization coverage of 3 incentives for physicians--a cash bonus for practice--wide increases, enhanced fee for service, and feedback.
Incentives were applied at 4-month intervals over 1 year among 60 inner-city office-based pediatricians. At each interval, charts of 50 randomly selected children between 3 and 35 months of age were reviewed per physician.
The percentage of children who were up to date for diphtheria, tetanus, and pertussis and Haemophilus influenzae type b; polio; and measles-mumps-rubella immunization in the study's bonus group improved by 25.3 percentage points (P < .01). No significant changes occurred in the other groups. However, percentage of immunizations received outside the participating practice also increased significantly in the bonus group (P < .01). Levels of missed opportunities to immunize were high in all groups and did not change over time. Physicians' knowledge of contraindications was low.
Bonuses sharply and rapidly increased immunization cover-age in medical records. However, much of the increase was the result of better documentation. A bonus is a powerful incentive, but more structure or education may be necessary to achieve the desired results.

9 Reads
  • Source
    • "Another disadvantage of practitioner-based incentive programs is that the incentives may reinforce reporting of health care improvements, even in the absence of any change in care. Such “improvements” may result from more accurate record keeping,4,82 or they may result from practitioners’ attempts to game the incentive-based intervention.83 For better or worse, whichever behavior is reinforced is the only one that is guaranteed to increase. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Behavior plays an important role in health promotion. Exercise, smoking cessation, medication adherence, and other healthy behavior can help prevent, or even treat, some diseases. Consequently, interventions that promote healthy behavior have become increasingly common in health care settings. Many of these interventions award incentives contingent upon preventive health-related behavior. Incentive-based interventions vary considerably along several dimensions, including who is targeted in the intervention, which behavior is targeted, and what type of incentive is used. More research on the quantitative and qualitative features of many of these variables is still needed to inform treatment. However, extensive literature on basic and applied behavior analytic research is currently available to help guide the study and practice of incentive-based treatment in health care. In this integrated review, we discuss how behavior analytic research and theory can help treatment providers design and implement incentive-based interventions that promote healthy behavior.
    Psychology Research and Behavior Management 03/2014; 7:103-114. DOI:10.2147/PRBM.S59792
  • Source
    • "We were not able to measure, however, a preintervention trend and look for a deviation from prior trends. Lastly, the data used for this study were not amenable to differentiating between better documentation and more complete immunization of the target population as has been noted in previous studies (Fairbrother et al. 1999, 2001). Differentiating between quality documentation and quality of care is an important distinction, but we have reason to believe that the overall quality of immunization documentation is more accurate and reliable than 15 years ago when previous studies noted that documentation and underlying care were dissociated. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the impact of a "piece-rate" pay for performance (P4P) program aimed at improving diabetes care processes, outcomes and related healthcare utilization for patients enrolled in a not-for-profit Medicaid-focused managed care plan. To evaluate Hudson Health Plan's P4P program in New York (2003-2007), we conducted: (1) a case-comparison difference-in-difference study using plan-level administrative data; (2) a patient-level claims data analysis; and (3) a cross-sectional survey. The case-comparison study found that diabetes care processes (e.g., HbA1c, lipid, and dilated eye exam rates) and outcomes (e.g., LDL-C<100mg/dL) did not improve significantly over the study period. Claims analysis showed that younger adults had significantly increased odds (OR 3.50-3.56, p<0.001) of using emergency and hospital-based services and similarly decreased odds of receiving recommended care process (OR 0.22-0.36, p<0.01-0.001). Survey study indicated that practices lack fundamental quality improvement infrastructures and training. Recent health legislation mandates the use of P4P incentives in government programs that disproportionately care for patients with lower socioeconomic or minority backgrounds (e.g., Medicaid, Veterans Health Administration, and Tricare). More research is needed in order to understand how to tailor P4P programs for vulnerable care settings.
    Preventive Medicine 11/2012; 55 Suppl:S80-5. DOI:10.1016/j.ypmed.2012.05.004 · 3.09 Impact Factor
  • Source
    • "Many incentives influence the immunization profile. The immunization rate in adults and the up-to-date immunization rate in children will improve with financial incentives [13] [14] [15]. Many studies hypothesized that different types of immunization providers and the cost of these providers will influence child healthcare willingness [1] [11] [16]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The immunization status of children is improved by interventions that increase community demand for compulsory and non-compulsory vaccines, one of the most important interventions related to immunization providers. The aim of this study is to evaluate the activities of immunization providers in terms of activities time and cost, to calculate the immunization doses cost, and to determine the immunization dose errors cost. Time-motion and cost analysis study design was used. Five public health clinics in Mosul-Iraq participated in the study. Fifty (50) vaccine doses were required to estimate activities time and cost. Micro-costing method was used; time and cost data were collected for each immunization-related activity performed by the clinic staff. A stopwatch was used to measure the duration of activity interactions between the parents and clinic staff. The immunization service cost was calculated by multiplying the average salary/min by activity time per minute. 528 immunization cards of Iraqi children were scanned to determine the number and the cost of immunization doses errors (extraimmunization doses and invalid doses). The average time for child registration was 6.7 min per each immunization dose, and the physician spent more than 10 min per dose. Nurses needed more than 5 min to complete child vaccination. The total cost of immunization activities was 1.67 US$ per each immunization dose. Measles vaccine (fifth dose) has a lower price (0.42 US$) than all other immunization doses. The cost of a total of 288 invalid doses was 744.55 US$ and the cost of a total of 195 extra immunization doses was 503.85 US$. The time spent on physicians' activities was longer than that spent on registrars' and nurses' activities. Physician total cost was higher than registrar cost and nurse cost. The total immunization cost will increase by about 13.3% owing to dose errors.
    Vaccine 04/2012; 30(26):3862-6. DOI:10.1016/j.vaccine.2012.04.014 · 3.62 Impact Factor
Show more

Similar Publications


9 Reads
Available from