{"title":"医疗机构的财政激励:规范性考虑的审查。","authors":"Roshni Jegan, Anuradha Rose, Kris Dierickx","doi":"10.1186/s12910-025-01252-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Institutional financial incentives(FIs) are used to improve the quality of healthcare services and patient outcomes. In spite of their growing use, empirical evidence regarding their impact remains inconclusive. Moreover, the normative implications of institutional FIs remain underexplored. This study aims to map the normative considerations and tensions in using institutional FIs in healthcare.</p><p><strong>Methods: </strong>We performed a systematic review of reasons to identify and map the normative considerations in institutional FIs. Six databases, namely PubMed, Embase, Scopus, Web of Science, ProQuest Central and EconPapers, and additionally Google Scholar were searched. We included peer-reviewed literature in English on financial incentives or pay-for-performance in healthcare at the institutional level, and excluded grey literature, and studies on individual provider incentives.</p><p><strong>Results: </strong>Sixteen articles met the inclusion criteria, representing diverse disciplines such as health economics, medicine, law, public health and health policy. Two categories of normative considerations are identified: firstly, considerations at the macro and meso level (societal and institutional level), and secondly, considerations at the micro (departmental or individual) level. The key normative principles identified are effectiveness, utility, solidarity, distributive justice, procedural justice, professional values, conflicts of interest and proportionality. The tensions inherent in each normative principle are closely linked to contextual elements such as institutional characteristics, incentive design and performance measures: for instance, the type of performance measure used (process or outcome measure, relative or absolute improvement) impacts procedural justice.</p><p><strong>Discussion: </strong>This study is limited in including only English language literature. Notwithstanding this limitation, this review provides an overview of the normative implications of institutional financial incentives. As robust empirical evidence on the institution and societal-level effects of FI is lacking, these findings emphasize the need for further normative deliberation on institutional FIs and more caution while implementing institutional FIs as a policy measure.</p>","PeriodicalId":55348,"journal":{"name":"BMC Medical Ethics","volume":"26 1","pages":"92"},"PeriodicalIF":3.0000,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12247344/pdf/","citationCount":"0","resultStr":"{\"title\":\"Institutional financial incentives in healthcare: a review of normative considerations.\",\"authors\":\"Roshni Jegan, Anuradha Rose, Kris Dierickx\",\"doi\":\"10.1186/s12910-025-01252-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Institutional financial incentives(FIs) are used to improve the quality of healthcare services and patient outcomes. In spite of their growing use, empirical evidence regarding their impact remains inconclusive. Moreover, the normative implications of institutional FIs remain underexplored. This study aims to map the normative considerations and tensions in using institutional FIs in healthcare.</p><p><strong>Methods: </strong>We performed a systematic review of reasons to identify and map the normative considerations in institutional FIs. Six databases, namely PubMed, Embase, Scopus, Web of Science, ProQuest Central and EconPapers, and additionally Google Scholar were searched. We included peer-reviewed literature in English on financial incentives or pay-for-performance in healthcare at the institutional level, and excluded grey literature, and studies on individual provider incentives.</p><p><strong>Results: </strong>Sixteen articles met the inclusion criteria, representing diverse disciplines such as health economics, medicine, law, public health and health policy. Two categories of normative considerations are identified: firstly, considerations at the macro and meso level (societal and institutional level), and secondly, considerations at the micro (departmental or individual) level. The key normative principles identified are effectiveness, utility, solidarity, distributive justice, procedural justice, professional values, conflicts of interest and proportionality. The tensions inherent in each normative principle are closely linked to contextual elements such as institutional characteristics, incentive design and performance measures: for instance, the type of performance measure used (process or outcome measure, relative or absolute improvement) impacts procedural justice.</p><p><strong>Discussion: </strong>This study is limited in including only English language literature. Notwithstanding this limitation, this review provides an overview of the normative implications of institutional financial incentives. As robust empirical evidence on the institution and societal-level effects of FI is lacking, these findings emphasize the need for further normative deliberation on institutional FIs and more caution while implementing institutional FIs as a policy measure.</p>\",\"PeriodicalId\":55348,\"journal\":{\"name\":\"BMC Medical Ethics\",\"volume\":\"26 1\",\"pages\":\"92\"},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2025-07-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12247344/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMC Medical Ethics\",\"FirstCategoryId\":\"98\",\"ListUrlMain\":\"https://doi.org/10.1186/s12910-025-01252-y\",\"RegionNum\":1,\"RegionCategory\":\"哲学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ETHICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Medical Ethics","FirstCategoryId":"98","ListUrlMain":"https://doi.org/10.1186/s12910-025-01252-y","RegionNum":1,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ETHICS","Score":null,"Total":0}
引用次数: 0
摘要
背景:机构财政激励(fi)是用来提高医疗服务质量和病人的结果。尽管它们的使用越来越多,但关于其影响的经验证据仍然不确定。此外,机构金融机构的规范含义仍未得到充分探讨。本研究的目的是映射规范的考虑和紧张使用机构金融机构在医疗保健。方法:我们对原因进行了系统的回顾,以确定和绘制机构金融机构的规范性考虑。检索PubMed、Embase、Scopus、Web of Science、ProQuest Central和EconPapers 6个数据库以及谷歌Scholar。我们纳入了同行评议的英文文献,内容涉及医疗机构层面的财务激励或绩效薪酬,排除了灰色文献和个人提供者激励的研究。结果:16篇文章符合纳入标准,涵盖卫生经济学、医学、法律、公共卫生和卫生政策等多个学科。确定了两类规范性考虑因素:首先是宏观和中观层面(社会和制度层面)的考虑因素,其次是微观层面(部门或个人)的考虑因素。确定的关键规范原则是有效性、效用、团结、分配正义、程序正义、专业价值、利益冲突和相称性。每个规范原则中固有的紧张关系与诸如制度特征、激励设计和绩效衡量等背景因素密切相关:例如,所使用的绩效衡量类型(过程或结果衡量、相对或绝对改善)影响程序正义。讨论:本研究仅局限于包括英语语言文学。尽管有这种限制,本审查提供了体制财政激励的规范性影响的概述。由于缺乏关于金融机构的制度和社会层面影响的强有力的经验证据,这些研究结果强调,需要对制度性金融机构进行进一步的规范性审议,并在将制度性金融机构作为一项政策措施实施时更加谨慎。
Institutional financial incentives in healthcare: a review of normative considerations.
Background: Institutional financial incentives(FIs) are used to improve the quality of healthcare services and patient outcomes. In spite of their growing use, empirical evidence regarding their impact remains inconclusive. Moreover, the normative implications of institutional FIs remain underexplored. This study aims to map the normative considerations and tensions in using institutional FIs in healthcare.
Methods: We performed a systematic review of reasons to identify and map the normative considerations in institutional FIs. Six databases, namely PubMed, Embase, Scopus, Web of Science, ProQuest Central and EconPapers, and additionally Google Scholar were searched. We included peer-reviewed literature in English on financial incentives or pay-for-performance in healthcare at the institutional level, and excluded grey literature, and studies on individual provider incentives.
Results: Sixteen articles met the inclusion criteria, representing diverse disciplines such as health economics, medicine, law, public health and health policy. Two categories of normative considerations are identified: firstly, considerations at the macro and meso level (societal and institutional level), and secondly, considerations at the micro (departmental or individual) level. The key normative principles identified are effectiveness, utility, solidarity, distributive justice, procedural justice, professional values, conflicts of interest and proportionality. The tensions inherent in each normative principle are closely linked to contextual elements such as institutional characteristics, incentive design and performance measures: for instance, the type of performance measure used (process or outcome measure, relative or absolute improvement) impacts procedural justice.
Discussion: This study is limited in including only English language literature. Notwithstanding this limitation, this review provides an overview of the normative implications of institutional financial incentives. As robust empirical evidence on the institution and societal-level effects of FI is lacking, these findings emphasize the need for further normative deliberation on institutional FIs and more caution while implementing institutional FIs as a policy measure.
期刊介绍:
BMC Medical Ethics is an open access journal publishing original peer-reviewed research articles in relation to the ethical aspects of biomedical research and clinical practice, including professional choices and conduct, medical technologies, healthcare systems and health policies.