Transforming Primary Care in Ireland : Information, Incentives, and Provider Capabilities

Ireland’s health system is at a key turning point. The Irish government was newly elected in February 2011, and the policy directions adopted over the coming months will likely exert a major impact on system performance for many years. Drawing on recent international experience with performance measurement and financial incentives, this paper examines strategies for enhancing quality and value in the Irish health system, focusing predominantly on the role of primary care. Three take-home messages emerge from the literature. First, substantial improvements in quality of care often can be attained at a reasonable cost, such as through the use of checklists and evidence-based clinical pathways, or by better aligning the skills of health care providers to patients’ need. Second, rigorous performance measurement is a vital tool for quality improvement that is lacking in Ireland, and this could be particularly powerful if underpinned by risk-adjustment to enable reliable evaluation of clinical outcomes. Pilot projects are required to examine the feasibility of these techniques in the Irish context. Third, although pay-for-performance is a prominent quality improvement strategy, little evidence exists to support its purported benefits and it can exert negative effects. Incentives are unlikely to be effective if providers lack the capability to respond appropriately, therefore it is imperative to foster professionalism and pride in high-quality care, and to develop the managerial and clinical skills necessary for high performance