The impact of physician bonuses, enhanced fees, and feedback on childhood immunization coverage rates

Objectives. The purpose of this study was to examine the effects on immuniz ation coverage of 3 incentives for physicians-a cash bonus for practice-wid e increases, enhanced fee for service, and feedback. Methods. Incentives were applied at 4-month intervals over 1 year among 60 inner-city office-based pediatricians. At each interval, charts of 50 rando mly selected children between 3 and 35 months of age were reviewed per phys ician. Results. The percentage of children who were up to date for diphtheria, tet anus, and pertussis and Haemophilus influenzae type b; polio and measles-mu mps-rubella immunization in the study's bonus group improved by 25.3 percen tage points (P<.01) No significant changes occurred in the other groups. Ho wever, percentage of immunizations received outside the participating pract ice also increased significantly in the bonus group (P<.01) Levels of misse d opportunities to Immunize were high in all groups and did not change over time. Physicians' knowledge edge of contraindications was low. Conclusions. Bonuses sharply and rapidly increased immunization coverage;in medical records. However, much of the increase was-the result of better do cumentation. A bonus is a powerful incentive, but more structure or educati on may be necessary to achieve the desired results.