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Perceptions and experiences of financial incentives: A qualitative study of dialysis care in England

Perceptions and experiences of financial incentives: A qualitative study of dialysis care in England
Perceptions and experiences of financial incentives: A qualitative study of dialysis care in England
Objective: The objective of the study was to understand the extent to which financial incentives such as Payment by Results and other payment mechanisms motivate kidney centres in England to change their practices. Design: The study followed a qualitative design. Data collection involved 32 in-depth semistructured interviews with healthcare professionals and managers, focusing on their subjective experience of payment structures. Participants: Participants were kidney healthcare professionals, clinical directors, kidney centre managers and finance managers. Healthcare commissioners from different parts of England were also interviewed. Setting: Participants worked at five kidney centres from across England. The selection was based on the prevalence of home haemodialysis, ranging from low (8%) prevalence, with at least one centre in each one of these categories at the time of selection. Results: While the tariff for home haemodialysis is not a clear incentive for its adoption due to uncertainty about operational costs, Commissioning for Quality and Innovation (CQUIN) targets and the Best Practice Tariff for vascular access were seen by our case study centres as a motivator to change practices. Conclusions: The impact of financial incentives designed at a policy level is influenced by the understanding of cost and benefits at the local operational level. In a situation where costs are unclear, incentives which are based on the improvement of profit margins have a smaller impact than incentives which provide an additional direct payment, even if this extra financial support is relatively small.
article dialysis financial management health care cost health care personnel home dialysis human manager perception qualitative research semi structured interview United Kingdom vascular access clinical trial economics England interview motivation multicenter study national health service reimbursement Renal Insufficiency Hemodialysis, Home Humans Interviews as Topic Reimbursement, Incentive State Medicine
2044-6055
Abma, I.
c3066b94-d007-44e8-9cb3-633d53565c33
Jayanti, A.
e35ba4f1-0efa-4b64-b616-c9fead53851f
Bayer, S.
28979328-d6fa-4eb7-b6de-9ef97f8e8e97
Mitra, S.
af07c97b-82f0-40bb-be1b-8216ee3c5246
Barlow, James
51253e7e-517c-48b6-98b0-ac82b00a600f
Abma, I.
c3066b94-d007-44e8-9cb3-633d53565c33
Jayanti, A.
e35ba4f1-0efa-4b64-b616-c9fead53851f
Bayer, S.
28979328-d6fa-4eb7-b6de-9ef97f8e8e97
Mitra, S.
af07c97b-82f0-40bb-be1b-8216ee3c5246
Barlow, James
51253e7e-517c-48b6-98b0-ac82b00a600f

Abma, I., Jayanti, A., Bayer, S., Mitra, S. and Barlow, James (2014) Perceptions and experiences of financial incentives: A qualitative study of dialysis care in England. BMJ Open, 4 (2), [e004249]. (doi:10.1136/bmjopen-2013-004249).

Record type: Article

Abstract

Objective: The objective of the study was to understand the extent to which financial incentives such as Payment by Results and other payment mechanisms motivate kidney centres in England to change their practices. Design: The study followed a qualitative design. Data collection involved 32 in-depth semistructured interviews with healthcare professionals and managers, focusing on their subjective experience of payment structures. Participants: Participants were kidney healthcare professionals, clinical directors, kidney centre managers and finance managers. Healthcare commissioners from different parts of England were also interviewed. Setting: Participants worked at five kidney centres from across England. The selection was based on the prevalence of home haemodialysis, ranging from low (8%) prevalence, with at least one centre in each one of these categories at the time of selection. Results: While the tariff for home haemodialysis is not a clear incentive for its adoption due to uncertainty about operational costs, Commissioning for Quality and Innovation (CQUIN) targets and the Best Practice Tariff for vascular access were seen by our case study centres as a motivator to change practices. Conclusions: The impact of financial incentives designed at a policy level is influenced by the understanding of cost and benefits at the local operational level. In a situation where costs are unclear, incentives which are based on the improvement of profit margins have a smaller impact than incentives which provide an additional direct payment, even if this extra financial support is relatively small.

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Accepted/In Press date: 10 January 2014
e-pub ahead of print date: 12 February 2014
Published date: 2014
Additional Information: Cited By :3 Export Date: 7 June 2017 Correspondence Address: Barlow, J.; Imperial College Business School, South Kensington Campus, London, United Kingdom; email: j.barlow@imperial.ac.uk Funding details: EPSRC, Engineering and Physical Sciences Research Council References: Shaw, C., Pruthi, R., Pitcher, D., (2012) UK Renal Registry 15th Annual Report: Chapter 2 UK RRT Prevalence in 2011: National and Centrespecific Analyses, , http://www.renalreg.com/Reports/2012.html; (2011) England Dialysis Capacity Survey As at October 2011, , http://www.kidneycare.nhs.uk/our_work_programmes/commissioning/ dialysis_capacity_survey/#; (2008) Delivering Care Closer to Home: Meeting the Challenge, , http://icn.csip.org.uk/_library/Delivering_care_closer_to_home.pdf, Department of Health; Beard, C., (2013) No Place Like Home: Increasing Access to Home Dialysis, , http://www.kidneycare.nhs.uk/our_work_programmes/ improving_choice_for_kidney_patients/home_therapies/; Dudley, R.A., Frolich, A., Robinowitz, D.L., (2004) Strategies to Support Quality-based Purchasing: A Review of the Evidence, , Rockville, MD; Petersen, L.A., Woodard, L.D., Urech, T., Daw, C., Sookanan, S., Does pay-for-performance improve the quality of health care? 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(2010) Br J Nurs, 19, pp. 1275-1276+1278-1280; Baboolal, K., McEwan, P., Sondhi, S., Spiewanowski, P., Wechowski, J., Wilson, K., The cost of renal dialysis in a UK setting - A multicentre study (2008) Nephrology Dialysis Transplantation, 23 (6), pp. 1982-1989. , DOI 10.1093/ndt/gfm870; McFarlane, P.A., Pierratos, A., Redelmeier, D.A., Cost savings of home nocturnal versus conventional in-center hemodialysis (2002) Kidney International, 62 (6), pp. 2216-2222. , DOI 10.1046/j.1523-1755.2002.00678.x; Kroeker, A., Clark, W.F., Heidenheim, A.P., An operating cost comparison between conventional and home quotidian hemodialysis (2003) Am J Kidney Dis, 42 (1 SUPPL.), pp. 49-55; Agar, J.W.M., Knight, R.J., Simmonds, R.E., Boddington, J.M., Waldron, C.M., Somerville, C.A., Nocturnal haemodialysis: An Australian cost comparison with conventional satellite haemodialysis (2005) Nephrology, 10 (6), pp. 557-570. , DOI 10.1111/j.1440-1797.2005.00471.x; Mohr, P.E., Neumann, P.J., Franco, S.J., Marainen, J., Lockridge, R., Ting, G., The case for daily dialysis: Its impact on costs and quality of life (2001) American Journal of Kidney Diseases, 37 (4), pp. 777-789; Komenda, P., Gavaghan, M.B., Garfield, S.S., An economic assessment model for in-center, conventional home, and more frequent home hemodialysis (2012) Kidney Int, 81, pp. 307-313; (2002) Guidance on Home Compared with Hospital Haemodialysis for Patients with End-stage Renal Failure, , http://publications.nice.org.uk/guidance-on-home-compared-with-hospital- haemodialysis-for-patients-with-end-stage-renal-failure-ta48; (2004) Part One - Dialysis and Transplantation, , https://www.gov.uk/government/publications/national-service-framework- kidney-disease, National Service Framework for Renal Services. Department of Health; (2011) Frequently Asked Questions: Payment by Results (PbR)-renal Dialysis, , http://www.kidneycare.nhs.uk/resources_old/faqs/; Patel, P.R., Kallen, A.J., Arduino, M.J., Epidemiology, surveillance, and prevention of bloodstream infections in hemodialysis patients Am J Kidney Dis, 56, pp. 566-577; (2012) Everyone Counts: Planning for Patients 2013-2014, , http://www.england.nhs.uk/wp-content/uploads/2012/12/everyonecounts- planning.pdf; Fluck, R., Kumwenda, M., (2011) Clinical Practice Guidelines - Vascular Access for Haemodialysis, , http://www.renal.org/Clinical/GuidelinesSection/VascularAccess. aspx#downloads; (2011) National Kidney Care Audit Vascular Access Report 2010, , http://www.hqip.org.uk/assets/NCAPOP-Library/National-Kidney-Care-Audit- Vascular-Access-Report-2010.pdf, NHS Information Centre; (2012) National Kidney Care Audit Vascular Access Report 2011, , http://www.hqip.org.uk/assets/NCAPOP-Library/ VAReport2011Interactive03082011-FINAL.pdf, NHS Information Centre; (2012) Tariff Information Spreadsheet, , https://www.gov.uk/government/publications/confirmation-of-payment-by- results-pbr-arrangements-for-2012-13, Department of Health; (2011) Payment by Results Guidance for 2011-12, , http://gp.dh.gov.uk/2011/03/28/updated-payment-by-results-pbr- arrangements-for-2011-12/; (2012) Payment by Results Guidance 2012-13, , https://www.gov.uk/government/publications/confirmation-of-payment-by- results-pbr-arrangements-for-2012-13, Department of Health; (2010) Commissioning for Quality and Innovation (CQUIN) Payment Framework - Summary of Indicators 2010-2011, , http://www.institute.nhs.uk/world_class_commissioning/pct_portal/cquin. html; Castledine, C., Casula, A., Fogarty, D., (2011) UK Renal Registry 14th Annual Report: Chapter 2 UK RRT Prevalence in 2010: National and Centre-specific Analyses, , http://www.renalreg.com/Reports/2011.html; Steenkamp, R., Castledine, C., Feest, T., (2010) UK Renal Registry 13th Annual Report: Chapter 2 UK RRT Prevalence in 2009: National and Centre-specific Analyses, , http://www.renalreg.com/Reports/2010.html; Jayanti, A., Weirden, A.J., Morris, J., Barriers to successful implementation of care in home haemodialysis (BASIC-HHD):1. Study design, methods and rationale (2013) BMC Nephrology, 14, p. 197; Adult kidney dialysis care best practice tariff/payment by results - FAQs for patients (2011) Carers and Non-clinicians, , NHS Kidney Care; (2008) Interim Report of the PbR for Renal Dialysis Project Group, , Department of Health; Sussex, J., Farrar, S., Activity-based funding for National Health Service hospitals in England: Managers' experience and expectations (2009) Eur J Health Econ, 10, pp. 197-206
Keywords: article dialysis financial management health care cost health care personnel home dialysis human manager perception qualitative research semi structured interview United Kingdom vascular access clinical trial economics England interview motivation multicenter study national health service reimbursement Renal Insufficiency Hemodialysis, Home Humans Interviews as Topic Reimbursement, Incentive State Medicine
Organisations: Decision Analytics & Risk

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Local EPrints ID: 410484
URI: http://eprints.soton.ac.uk/id/eprint/410484
ISSN: 2044-6055
PURE UUID: 38de0c26-32b1-47bc-bed9-54c53b938f36
ORCID for S. Bayer: ORCID iD orcid.org/0000-0002-7872-467X

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Date deposited: 09 Jun 2017 09:00
Last modified: 27 Jan 2020 13:30

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Author: I. Abma
Author: A. Jayanti
Author: S. Bayer ORCID iD
Author: S. Mitra
Author: James Barlow

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