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Qualität und Sicherheit dienen als Projektionsfläche für die unterschiedlichsten Problemstellungen im deutschen Gesundheitssystem. Tragfähige Zielvorstellungen als Basis für die Weiterentwicklung der Qualitätssicherung in Deutschland sind jedoch nicht in Sicht, Glaubwürdigkeit und Vertrauen in Instrumente und Begrifflichkeiten gehen verloren. Wir fahren fort, Menge statt Qualität zu finanzieren, sektorale Abschottung geht über Zusammenarbeit. Bei allen gesetzgeberischen Aktivitäten - ein grundlegender Reformansatz ist bislang nicht erkennbar. Hier setzt Qualität 2030 an und schlägt
Public health --- International cooperation. --- International agencies --- Medical assistance --- Public health laws, International --- World health --- quality --- Pay for Performance --- transparency --- reform --- health policy
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In China, health care providers have traditionally been paid fee-for-service and overprescribing and high out-of-pocket spending are common. In this study, township health centers in two counties were assigned almost randomly to two groups: in one, fee-for-service was replaced by a global capitated budget; in the other, by a mix of global capitated budget and pay-for-performance. Performance captured inter alia "irrational" drug prescribing; 20 percent of the global capitated budget was withheld each quarter, points were deducted for failure to meet targets, and some of the withheld budget was returned in line with the points deducted. Outcomes included appropriate prescribing and prescription cost, data on which were obtained by digitizing prescriptions from a month just before the reform and from the same month a year later. Impacts were assessed via multivariate differences-in-differences with township health center fixed effects. To reduce bias from non-randomness in assignment, the sample was trimmed by coarsened exact matching. Pay-for-performance reduced inappropriate prescribing significantly and substantially in the county where the initial level was above the penalty threshold, but end-line rates were still appreciable; no effects were seen in the county where initial levels were around or below the threshold, or on out-of-pocket spending in either county.
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How the obsession with quantifying human performance threatens business, medicine, education, government-and the quality of our livesToday, organizations of all kinds are ruled by the belief that the path to success is quantifying human performance, publicizing the results, and dividing up the rewards based on the numbers. But in our zeal to instill the evaluation process with scientific rigor, we've gone from measuring performance to fixating on measuring itself-and this tyranny of metrics now threatens the quality of our organizations and lives. In this brief, accessible, and powerful book, Jerry Muller uncovers the damage metrics are causing and shows how we can begin to fix the problem. Filled with examples from business, medicine, education, government, and other fields, the book explains why paying for measured performance doesn't work, why surgical scorecards may increase deaths, and much more. But Muller also shows that, when used as a complement to judgment based on personal experience, metrics can be beneficial, and he includes an invaluable checklist of when and how to use them. The result is an essential corrective to a harmful trend that increasingly affects us all.
Organizational effectiveness --- Performance --- Measurement. --- Evaluation. --- Abstract knowledge. --- Embracing the Fog of War. --- From Higher Aims to Hired Hands. --- KPI. --- Mass Flourishing. --- No Child Left Behind. --- accountability. --- balanced scorecard. --- behavioral systems analysis. --- competitive advantage. --- formulaic knowledge. --- higher education. --- innovation. --- key performance indicators. --- metric fixation. --- organizational complexity. --- pay for performance. --- pay-for-performance. --- performance effects. --- performance measurement. --- performance problem. --- productivity. --- time loss. --- transparency. --- value-added testing.
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This publication reviews performance pay schemes covering middle management and senior management levels in departments and agencies of central government and also looks at, on a selective basis, schemes for managers in other parts of the public sector. The objectives of the study were to investigate why performance-related pay schemes are being introduced at management levels in the public sector, to examine how these schemes operate, to assess whether the schemes are meeting their stated objectives, and tosee whether and under what conditions performance pay can operate successfully in public sector settings.
Governance --- Government executives --- Merit pay --- Salaries, etc --- Rating of --- Merit increases --- Merit pay programs --- Merit pay systems --- Merit-type salary schedules --- Pay for performance --- Salary schedules, Merit-type --- Variable pay --- Performance awards --- Wages --- Executives --- Public officers
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Arbeitnehmer werden nicht mehr nur als Kostenfaktor betrachtet, der möglichst minimiert werden sollte, vielmehr wird ihnen ein Anteil an der Wertschöpfung beigemessen. Ihr Beitrag zum Unternehmenserfolg in Form ihrer Arbeitsleistung soll entsprechend honoriert werden.Diese Erkenntnisse führten zur Idee der variablen Vergütungssysteme. Diesen ist immanent, dass sie gleichzeitig eine Anreizwirkung und eine Belohnungsfunktion innehaben. Zum einen werden Mitarbeiter zu höheren Leistungen motiviert und für diese mit einem leistungs- bzw. erfolgsabhängigen Vergütungsbestandteil entlohnt. Zum anderen wird dabei eine Übereinstimmung der Handlungen der Arbeitnehmer mit den Unternehmenszielen angestrebt. Arbeitgeber müssen bei der Ausgestaltung variabler Vergütungssysteme sehr genau auf die Formulierung achten. Die Rechtsprechung des BAG fordert, dass diese Systeme klar und transparent ausgestaltet sind. Unklarheiten gehen im Zweifel zulasten des Unternehmens.
Wage payment systems. --- Merit pay. --- Merit increases --- Merit pay programs --- Merit pay systems --- Merit-type salary schedules --- Pay for performance --- Salary schedules, Merit-type --- Variable pay --- Performance awards --- Wages --- Pay structure --- Compensation / Law, compensation systems.
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This study examines the effect of performance incentives for health care providers to provide more and higher quality care in Rwanda on child health outcomes. The authors find that the incentives had a large and significant effect on the weight-for-age of children 0-11 months and on the height-for-age of children 24-49 months. They attribute this improvement to increases in the use and quality of prenatal and postnatal care. Consistent with theory, They find larger effects of incentives on services where monetary rewards and the marginal return to effort are higher. The also find that incentives reduced the gap between provider knowledge and practice of appropriate clinical procedures by 20 percent, implying a large gain in efficiency. Finally, they find evidence of a strong complementarity between performance incentives and provider skill.
Adolescent Health --- Child health --- Disease Control & Prevention --- Health Monitoring & Evaluation --- Health services --- Health Systems Development & Reform --- Health, Nutrition and Population --- Impact evaluation --- Pay-for-performance --- Performance incentives --- Population Policies --- Provider payment --- Results-based financing --- Social Development
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The Three-Gap Model examines the determinants of low-quality health care by examining the patterns and determinants of three gaps. Using four measures of performance-target performance, actual performance, capacity to perform, and knowledge to perform-this paper defines three gaps for each health worker: the gap between target performance and what they have the knowledge to do (the know gap), the gap between their knowledge and their capacity to perform (the know-can gap), and the gap between their capacity and what they actually do (the can-do gap). The paper demonstrates how the patterns of these gaps across health workers in a sample can be used to diagnose failures in the system as well as evaluate the outcomes of policy experiments. Using data on pediatric care from hospitals in Liberia, the paper illustrates how the model can be used to investigate the potential for improvements in the quality of care from several possible policy interventions. The analysis of the relationships between these gaps across health workers in a health system help to paint a better picture of the determinants of performance and can assist policy makers in choosing relevant policies to improve health worker performance.
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Argentina's Plan Nacer provides insurance for maternal and child health care to uninsured families. The program allocates funding to provinces based on enrollment of beneficiaries and adds performance incentives based on indicators of the use and quality of maternal and child health care services and health outcomes. The provinces use these resources to pay health facilities to provide maternal and child health care services to beneficiaries. This paper analyzes the impact of Plan Nacer on birth outcomes. The analysis uses data from the universe of birth records in seven Argentine provinces for 2004 to 2008 and exploits the geographic phasing in of Plan Nacer over time. The paper finds that the program increases the use and quality of prenatal care as measured by the number of visits and the probability of receiving a tetanus vaccine. Beneficiaries' probability of low birth-weight is estimated to be reduced by 19 percent. Beneficiaries have a 74 percent lower chance of in-hospital neonatal mortality in larger facilities and approximately half this reduction comes from preventing low birth weight and half from better postnatal care. The analysis finds that the cost of saving a disability-adjusted life year through the program was USD 814, which is highly cost-effective compared with Argentina's USD 6,075 gross domestic product per capita over this period. Although there are small negative spillover effects on prenatal care utilization of non-beneficiary populations in clinics covered by Plan Nacer, no spillover is found on their birth outcomes.
Adolescent Health --- Birth Outcomes --- Disease Control & Prevention --- Health Monitoring & Evaluation --- Health Systems Development & Reform --- Health, Nutrition and Population --- Impact Evaluation --- Maternal and Child Health --- Pay-for-Performance --- Population Policies --- Provider Performance --- Results-Based Financing
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This paper reports on a two-tiered experiment designed to separately identify the selection and effort margins of pay-for-performance (P4P). At the recruitment stage, teacher labor markets were randomly assigned to a 'pay-for-percentile' or fixed-wage contract. Once recruits were placed, an unexpected, incentive-compatible, school-level re-randomization was performed, so that some teachers who applied for a fixed-wage contract ended up being paid by P4P, and vice versa. By the second year of the study, the within-year effort effect of P4P was 0.16 standard deviations of pupil learning, with the total effect rising to 0.20 standard deviations after allowing for selection.
Civil Service Reform --- Education --- Education Reform and Management --- Effective Schools and Teachers --- Field Experiment --- Incentives --- Labor Market --- Pay-For-Performance --- Performance Pay --- Primary Education --- Public Sector Development --- Teacher Recruitment --- Teacher Retention
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This study examines the effect of performance incentives for health care providers to provide more and higher quality care in Rwanda on child health outcomes. The authors find that the incentives had a large and significant effect on the weight-for-age of children 0-11 months and on the height-for-age of children 24-49 months. They attribute this improvement to increases in the use and quality of prenatal and postnatal care. Consistent with theory, They find larger effects of incentives on services where monetary rewards and the marginal return to effort are higher. The also find that incentives reduced the gap between provider knowledge and practice of appropriate clinical procedures by 20 percent, implying a large gain in efficiency. Finally, they find evidence of a strong complementarity between performance incentives and provider skill.
Adolescent Health --- Child health --- Disease Control & Prevention --- Health Monitoring & Evaluation --- Health services --- Health Systems Development & Reform --- Health, Nutrition and Population --- Impact evaluation --- Pay-for-performance --- Performance incentives --- Population Policies --- Provider payment --- Results-based financing --- Social Development
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