Pay-for-performance programs may be blocking access to healthcare for the less affluent, according to a study published Dec. 6 by Health Affairs.
Increasingly, individuals in less-affluent areas are having trouble accessing high-quality care, and pay-for-performance incentives--which can reward technology investment--are helping to widen the gap, the study authors wrote. Also, with hospital construction taking place mostly in affluent areas and technology not making its way as much into hospitals in less-affluent areas, the quality of care for the poor may be falling behind.
"It's something that's underappreciated," said Robert Hurley, an author of the study and associate professor of health administration at Virginia Commonwealth University.
The study also said current pay-for-performance models don't typically adjust for socioeconomic factors to equalize differences in patients' access to care and allow for fair comparison. Without those adjustments, providers who receive lower reimbursement for care of the underinsured or uninsured face the threat of widening disparities in resources compared with providers who care for better-insured patients, according to the study.
Hurley said incentive payments need to be adjusted because hospitals in less-affluent communities treat sicker patients who often delay seeking care because they can't afford it compared with the patients treated by hospitals in affluent areas. He said hospitals are building in areas that have higher rates of insured people in an effort to realize greater returns on their investment, not because they are socially irresponsible.
But an accompanying editorial by Timothy Ferris, an assistant professor at the Harvard Medical School, and David Blumenthal, director of Harvard University's program for health systems improvement, said Hurley's article may be overly negative since it was based on case studies and not quantitative data. The report used data gathered from interviews conducted by the Center for Studying Health System Change of healthcare professionals in 12 random communities.
As for the slow technology adoption in hospitals in less-affluent areas, WellPoint--one of the insurers the study mentioned that has started pay-for-performance plans--said costly technology isn't a necessary requirement of improved quality, according to e-mailed comments from a spokeswoman.