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目的尽管绩效薪酬已被广泛应用,但是能证明其有效性的证据却少之又少。此研究评价了加拿大安大略省的初级护理医师引入绩效薪酬与癌症检出率提升的相关性,并且将确定医师的薪酬作为此项研究的一部分。方法对管理数据进行纵向分析,以确定1999—2000年到2009—2010年每一财政年度的癌症检出率和激励成本。通过分段线性回归分析,评价在2006—2007年引进激励后,癌症检出率的趋势是否有变化或急剧变化。分析中纳入了所有安大略省的宫颈癌、乳腺癌和结肠癌的检查。结果研究发现,引进激励后3种癌症的检出率并没有发生较大变化。结肠癌检出率在引进激励前每年的增长速度为3.0%〔95%CI(2.3%,3.7%)〕,引进激励之后每年为4.7%〔95%CI(3.7%,5.7%)〕。引进激励后,宫颈癌和乳腺癌每年的检出率未见较大变化。2006—2007年到2009—2010年,分别投入了2 830万、3 130万和5 000万美元用于宫颈癌、乳腺癌和结肠癌的财政激励。结论尽管投入了大量财政成本,绩效薪酬计划几乎未能改善检出率。决策者应考虑其他策略提升癌症检出率。
Purpose Although performance pay has been widely used, there is very little evidence of its effectiveness. This study assesses the correlation between the introduction of pay for performance and the increase in cancer detection among primary care physicians in Ontario, Canada, and identifies the physician’s remuneration as part of the study. Methodology Longitudinal analysis of management data was conducted to determine the cancer detection rates and incentive costs for each financial year from 1999-2000 to 2009-2010. By piecewise linear regression analysis, to assess whether there is any change or sharp change in the trend of cancer detection after the introduction of incentives in 2006-2007. The analysis included all Ontario examinations of cervical, breast and colon cancer. Results The study found that after the introduction of incentives, the detection rate of the three kinds of cancer did not change much. The detection rate of colon cancer was 3.0% (95% CI 2.3%, 3.7%) per year before the introduction of incentives and 4.7% (95% CI 3.7%, 5.7%) annually after the introduction of incentives. After the introduction of incentives, the annual detection rate of cervical cancer and breast cancer showed no major changes. Between 2006-2007 and 2009-2010, a total of 28.3 million, 31.3 million and 50 million United States dollars respectively were invested in financial incentives for cervical, breast and colon cancer. Conclusion Despite significant financial costs, performance pay plans have almost failed to improve the detection rate. Policymakers should consider other strategies to increase the rate of cancer detection.