By David A. Kindig, MD, PhD
Those of us who care about health are convinced that a realigning of incentives is in order to encourage the production of health rather than the treatment of disease. We recognize an imbalance in how funds are allocated, but decisions about the division of the existing pie (among healthcare access, public health, education, early childhood, housing, food access, economic development, environmental quality, etc.) are currently and unfortunately as much political as scientific. (Reflections on how we might make the pie bigger will have to await another post.)
The latest issue of Preventing Chronic Disease features a series of essays on incentives for population health improvement that were commissioned through a Robert Wood Johnson Foundation grant. This is the second in a series of three special issues (the first focused on metrics and the last will focus on partnerships).
The diverse collection of essays highlights key concepts and perspectives on the promise and pitfalls of both financial and non-financial incentives. They are accompanied by two helpful commentaries (Lewis and McGinnis).
Topics include:
- The nature and function of financial and non-financial incentives (Haveman)
- The applicability and unintended consequences of “pay for performance” systems in healthcare (Asch and Werner) and education (Witte)
- The need to make better use of and enforce existing resources and policies for population health improvement (Baxter)
- Potential roles for non-financial incentives such as rankings (Oliver), target setting (Smith), and social marketing (Rothschild)
- Whether and how savings from healthcare (a “value dividend”) could be reallocated and applied for broad population health benefit (Fox)
- An economic perspective on the “production” of population health and the role that multiple sectors play as “promoters” and “inhibitors” of outcomes (Mullahy)
The pieces are relevant to policymakers, practitioners, and researchers and provide much food for thought. With resources likely to remain limited for the foreseeable future, we must continue to think very carefully and work to better understand how our investment strategies and decisions (dollar and otherwise) influence the health of our communities.
For me, the essays highlight the two most important tasks for the field of population health in the coming decade:
1) Identify the most cost effective balance of population health promoting investments tailored to the outcomes and determinants profile of individual communities, and
2) Find the incentive strategies to create such investments.
Can our research and policy/practice communities meet these challenges?
David A. Kindig, MD, PhD, is Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin School of Medicine and Public Health.
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