As expected, avoiding unintended consequences (negative payment outcomes) is generally of higher importance than intended 'improvement' consequences (positive outcomes).
The importance rankings of the 12 performance domains led us to select 11 performance domains most likely to influence the preferences for care payment outcomes.
The eleven performance domains are the main independent variables which are assumed categorical, having the 'positive'negativeive' and 'no change' payment outcomes as levels.
Eleven reviews examined the effectiveness of financial strategies and the majority of these could not calculate an overall effect estimate due to heterogeneity, including the type of financial payment (eg, performance-based payment, capitation, fee-for-service), the size of payment, outcomes measured, targeted behaviour and the context/setting in which they were implemented.
When economic differences are taken into account, especially when the upstream state is richer, the side-payment outcome is reversed.
While linking payment to outcome makes sense, it could easily make doctors reluctant to accept severely ill patients or those with complex conditions.
For the MBS gap payment, this outcome was dichotomized into whether a gap payment was made or not as the data were skewed.
Frequent applications of CMGs are found in development of specific lengths of stay, payment models, outcome measures and benchmarking initiatives [ 24].
One of these, more than any other, could be the key to unlocking a sustainable public services future: payment by outcomes.
Payment by outcomes essentially means that a proportion of the payment, from central or local government to providers, is dependent on achieving specified results, for instance, reducing the reconviction rate among young offenders or finding sustainable employment for someone who has been out of work for a long time.
While payment by outcomes can be an incentive for focusing on keeping people in jobs long-term, it can have the opposite effect if the targets are too rigid and difficult.
