Melbourne Institute of Applied Economic and Social Research - Research Publications

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Type: Journal Article × Author: Scott, Anthony × Author: Zaresani, Arezou × Start date: 2020 × End date: 2022 ×

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    Is the evidence on the effectiveness of pay for performance schemes in healthcare changing? Evidence from a meta-regression analysis
    Zaresani, A ; Scott, A (BMC, 2021-02-24)
    Background: This study investigated if the evidence on the success of the Pay for Performance (P4P) schemes in healthcare is changing as the schemes continue to evolve by updating a previous systematic review. Methods: A meta-regression analysis using 116 studies evaluating P4P schemes published between January 2010 to February 2018. The effects of the research design, incentive schemes, use of incentives, and the size of the payment to revenue ratio on the proportion of statically significant effects in each study were examined. Results: There was evidence of an increase in the range of countries adopting P4P schemes and weak evidence that the proportion of studies with statistically significant effects have increased. Factors hypothesized to influence the success of schemes have not changed. Studies evaluating P4P schemes which made payments for improvement over time, were associated with a lower proportion of statistically significant effects. There was weak evidence of a positive association between the incentives’ size and the proportion of statistically significant effects. Conclusion: The evidence on the effectiveness of P4P schemes is evolving slowly, with little evidence that lessons are being learned concerning the design and evaluation of P4P schemes.
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    Does digital health technology improve physicians' job satisfaction and work-life balance? A cross-sectional national survey and regression analysis using an instrumental variable
    Zaresani, A ; Scott, A (BMJ Journals, 2020-01-01)
    Objectives To examine the association between physicians’ use of digital health technology and their job satisfaction and work–life balance. Design A cross-sectional nationally representative survey of physicians and probit regression models were used to examine the association between using digital health technology and the probability of reporting high job satisfaction and a good work–life balance. Models included a rich set of covariates, including physicians’ personality traits, and instrumental variable analysis was used to control for bias from unobservable confounders and reverse causality. Setting Clinical practice settings in Australia, including physicians working in primary care, hospitals, outpatient settings, and physicians working in the public and private sectors. Participants Respondents to wave 11 (2018–2019) of the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal survey of doctors. The analysis sample included a broadly nationally representative sample of 7043 physicians, including general practitioners, specialists and physicians in training. Primary and secondary outcome measures The proportion of respondents who used any digital health technology; proportion answered ‘moderately satisfied’ or ‘very satisfied’ to the statement on job satisfaction: ‘Taking everything into account, how do you feel about your work’; proportion agreeing or strongly agreeing to the statement on work–life balance: ‘The balance between my personal and professional commitments is about right.’ Results Physicians with positive beliefs about the effectiveness of using digital health technology were 3.8 percentage points (95% CI 2.7 to 5.0) more likely to use digital health technology compared with those who did not. Physicians with colleagues who already used digital health technology were also 4.1 percentage points (95% CI 2.6 to 5.6) more likely to use digital health technology. The availability of IT support and lack of privacy concerns increased the probability of using digital health technology by 1.6 percentage points (95% CI 1.0 to 2.3) and 0.5 percentage points (95% CI 0.1 to 1.0). Physicians who used digital health technology were 14.2 percentage points (95% CI −1.3 to 29.7) and 20.3 percentage points (95% CI 2.4 to 38.1) more likely to report respectively higher job satisfaction and good work–life balance, compared with the physicians who did not use it. Conclusions Findings suggested digital health technology served more as a work resource than work demand for physicians who used it.