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Best Practices of the Existing Performance Systems of the UAE

According to Margolis, Al-Marzouqi, Revel, and Reed (2003), the current performance systems are based on offering incentives to service providers. The incentives that are commonly applied in the UAE are those that involve the application of extra pay and monetary incentives. The latter lead to the development of a criterion that is known as pay for performance. Thus, pay for performance can be set based on the particular idea that the UAE has put on the medical practitioners since they now believe that there is no way they can offer proper healthcare services unless they are paid for well. However, the incentives are not so beneficial since practitioners also tend to find new ways of making their services seem excellent while they are not such in reality.

The UAE has the premise that pay for performance programs foster the ability of service providers to administer the desired services. Although this idea cannot be disputed, certain institutional factors affect the premise. Various institutional aspects may have different effects on the provider performance and the quality of the service as they are independent of financial issues. Thus, Ezziane et al. (2012) are of the opinion that the consequences of pay for performance concept could be unintended and they might detract from health systems objectives. It can be said that ultimately for hospitals in the United Arab Emirates, such as the Al Salama Hospital, Mafraq Hospital, and the LLH Hospital of Abu Dhabi, the quality of service provision depends on the interaction between institutional factors and the financial aspect of the incentives, offered to doctors.

Discussion

The above literature provides an insight on the significance of pay for performance programs. According to the various reports used in the literature review, the programs are quite beneficial to those patients in the UAE who are able to pay for their medical services. A culture has been developed in the Emirates’ health services sector that a patient has to provide adequate pay to access high quality medical care. Therefore, the pay for performance culture creates a gap in medical care provision between financially capable patients and the less fortunate ones. The literature provided in the research reports was quite sufficient in highlighting these issues regarding the program.

Effects of Pay for Performance

Net Substitution Effect

This effect takes into account the fact that health practitioners substitute valuable activities for less relevant activities. Financial incentives will influence the direction taken by medical professionals (Salisbury, 2009). If a certain practice is highly paid, doctors will tend to abandon all other practices and go for the highly paid practice even when the procedure for the practices not required.

Net Spillover Effects

Margolis et al. (2003) believe that the net spillover effect, which occurs due to pay for performance practices, includes benefits and faults that occur as the result of the program. In essence, pay for performance program has many positive results. Firstly, it enables the UAE medical practitioners to perform studies of the most common diseases based on the data collected from the system. It also enables doctors to learn the latest techniques in the medical industry. The down part of this spillover effect is that the program nullifies teamwork. The program fosters the need for medical practitioners to become individualistic as they compete for bonuses.

Net Costs

Pay for performance programs are typically cost intensive. The system has to use money for the purposes of running the system itself and for the reporting of data gained in the system (Salisbury, 2009). The system is also found to use hospital resources that would have been used to finance other medical processes. Thus, pay for performance programs seem to be the main way of achieving better purchase performance systems for the healthcare sector of the UAE (Ezziane et al., 2012). The performance systems are aimed at improving the quality of healthcare, counteracting the fee for service payment through better care, reducing health disparities, and developing the application of data bases and information technology systems.

Performance Measures

Depending on the objectives of a particular pay for performance program or institutional goals, a given system's performance can be measured. Usually, the most performance-oriented aspect, which is checked, is the clinical quality perspective. The quality that is monitored in the hospitals of UAE is the aspect of structure, process, and the outcome of the patient - whether they were treated well or not. Structure refers to the healthcare setting, the facility equipment, and supplies that a particular hospital has (Margolis et al., 2003). A well-performing hospital is the one that invests in its infrastructure. Process refers to the procedures followed in providing healthcare services (Younies, Barhem, Younis, 2008). Further, a method can be used to ensure that the UAE hospitals maintain quality. A penalty program can be created. In the program, hospitals that have higher rates of potentially preventable complications are penalized. The annual funds allocated to them are reallocated to better-performing hospitals.

Coverage of Priority Services and Their Efficiency

Usually, in high-income countries that rely on a fee for service methods of service delivery, the main issue with efficiency is to ensure that there is no excess demand for high technology in the treatment processes especially when it comes to chronic diseases (Suliman Al-Sabri, 2009). The UAE can be said to belong to this category.

Patient Experience

Customer experience refers to the manner. in which patients are treated in a hospital. The treatment ranges from how quickly service practitioners react to patients’ needs to the general way, in which treatment is performed and any other additional services that the patient might receive (Younies, Barhem, Younis, 2008). The deputy for quality and patient safety policy of the United Arab Emirates says that it is essential for every hospital in the nation to give the public their best possible service. The best service provision involves the engagement of patients in service delivery and decision-making.

Recommendations

The subject of health performance improvement is a topic with very little empirical research. Most information on performance improvement is based on the best interest of the patients. However, it is recommendable for future researchers to consider the aspect of proper employee training and motivation as a way to promote treatment accountability in health services. In the case of improvement of patient experience, it can be enhanced by implementing various services such as the ones used by Al Salama Hospital that helps new mothers celebrate childbirth.

As for improvement in existent HIS, the issue of substituting practices from less valuable methods to more useful practices for the purposes of earning more can be checked by the inclusion of other incorruptible doctors to correct such an issue. The payment for performance program can be implemented in the top hospitals to make sure that the nation can identify any incoming communicable diseases and the system is of help to curb such pandemics (Ezziane et al., 2012). To reduce the individualism that might be encouraged by the system, the nation can develop such a system that also registers bonuses for doctors based on teamwork. The government should also introduce a proper financial system that can cater for the costs consumed by the development of purchase performance systems.

The purchasing performance system in hospitals in the UAE is the one that focuses on assessing the performance of doctors by the treatment that patients undergo and the outcome after they leave the hospital that is based on whether the patients get better or not. Another important aspect as discussed is the credibility of the hospital to treat certain diseases that are known to be treatable. It has been seen that to accomplish the best performance treatment, it is paramount for patients to pay for it. It has been observed that pay for performance system involves many effects that befall the medical industry. These effects are both positive and negative, indicating that pay for service program is not entirely wrong since from the preceding, one can see that it gives doctors a motivation to work harder. The practices, performed by doctors, have various drawbacks such as those developed from pay for services programs.

There have been various recommendations for the purposes of improving the HIS performance systems in the future, and they include the inclusion of incorruptible doctors and even the encouragement of physicians to get involved in teamwork activities. It has been discussed that the motivation provided for doctors depends on the country in which the doctor is, whether it has a good or bad economy. For the countries with low-ranking economies, doctors are mainly civil servants who rely on a monthly pay check, while the nations, such as the UAE, can afford to pay their doctors according to the amount and kind of work performed. Thus, it has been clear that for the UAE, individual patients have to cater for their own fees, depending on what kind of service they expect to receive.