Negative effects, in terms of less quality improvement compared to non P4P use, which were first reported in the review paper by Petersen et al (2006) [ 14], are rarely encountered within the 128 studies, but do occur exceptionally.
He also noted that smartphones and laptops may enable some parents to spend more time at home, which may, in turn, result in more, rather than less, quality time overall.
The better quality of studies showing elevated plasma IL-8 levels in FMS patients compared to controls favors this finding, although in more studies (with less quality) no intergroup difference could be found.
The better quality of studies showing elevated serum IL-6 levels in FMS patients compared to controls favors this finding, although in more studies (with less quality) no intergroup difference could be found.
Qualitative and quantitative data indicate that providers at high-functioning integrated clinics perceived improved technical quality, service efficiency and cost-benefits but also noted increases in workloads, less quality time with clients and occupational stress.
Koeman complained that, at the other end, "we are showing less quality in an attacking way and less sharpness in the box".
"I felt like we were getting less quality in some areas".
It is noteworthy that 'negative' in this context means less quality improvement compared to non P4P use and not a quality decline.
In the long term certainly not because it creates more instability and instability creates less quality people in the jobs".
Yes, there is more choice and more competition yet this has resulted in less creativity and quality.
As noted above, rapid expansion of centers may result in less focus on quality.
