Brulin, E. and Teoh, Kevin (2024) Performance-based reimbursement, illegitimate tasks, moral distress and quality care in primary care: a mediation model of longitudinal data. Annals of Family Medicine , ISSN 1544-1709. (In Press)
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Abstract
Purpose: To test the direct and indirect effect that performance-based reimbursement (PBR) within primary care has on perceived individual and organizational quality of care, and the role of illegitimate tasks and moral distress as potential mediators. Method: We used the Longitudinal Occupational Health survey in Healthcare Sweden with data collected in 2021, 2022, and 2023, including 454 Swedish primary care physicians. PBR was measured using a single item. The Bern Illegitimate Tasks Scale measured illegitimate tasks, and moral distress was measured with a 10-item scale. Six items from the English National Health Staff Survey were used to measure the quality of individual and organizational care. Result: Of the 454 participants, 70.2% reported that PBR negatively impacted their work. PBR was negatively associated with illegitimate tasks (b, -.160 [CI, -.240, -.080]) and moral distress (b, -.134 [CI, -.210, -.058]), which in turn was associated with individual and organizational quality of care. Using mediation models, we found an indirect (b, .011 [CI, .004, .021]) but no direct (b, .062 [CI, .019, .143]) effect between PBR on the quality of individual care. Conclusion: PBR systems should account for the experience of individual primary care physicians to ensure effective, safe, and quality care, as this study shows how the level of illegitimate tasks and moral distress due to a PBR system can undermine care delivery. Consequently, it is imperative for stakeholders to consider how healthcare systems relate to the healthcare workforce’s work experience, well-being, and the care being provided.
Metadata
| Item Type: | Article |
|---|---|
| Keyword(s) / Subject(s): | Quality of care, Reimbursement, Primary health care, Physicians |
| School: | Birkbeck Faculties and Schools > Faculty of Business and Law > Birkbeck Business School |
| Depositing User: | Kevin Teoh |
| Date Deposited: | 20 Nov 2024 14:18 |
| Last Modified: | 20 Nov 2024 14:18 |
| URI: | https://eprints.bbk.ac.uk/id/eprint/54562 |
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