Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 2 appraisals
The British journal of general practice : the journal of the Royal College of General Practitioners
General practice incentives: a review of the international literature.
BACKGROUND: In Australia, the general practice sector faces significant challenges, leading to a re-evaluation of its predominantly fee-for-service (FFS) funding models. AIM: To conduct a systematic review of reviews that evaluated the efficacy of funding models in general practice on quality outcomes in multidisciplinary primary and preventive care for people with complex chronic conditions, as well as the contextual factors that have influenced their implementation. DESIGN AND SETTING: Only systematic reviews and meta-analyses were included. Search terms covered funding mechanisms, primary care, and general practice. The review followed PRISMA guidelines for systematic reviews. METHOD: PubMed, Cochrane, Embase, CINAHL, PsycInfo, PAIS, and Web of Science databases were searched in November 2023 for publications from 2010 onwards. RESULTS: Twenty reviews were included. Blended payment models incorporating pay-for-performance (P4P) with either capitation payments or FFS were associated with small improvements in quality outcomes, particularly in multidisciplinary settings. Changes in intermediate health outcomes and process measures for people with complex chronic conditions were most evident in diabetes care but inconclusive for other health outcomes and conditions. Improvements were mainly observed in incentivised activities and in less rigorously designed studies, with ceiling effects and variation reported across healthcare systems. There was no evidence that introducing capitation payments as part of blended payments improved quality of care. CONCLUSION: Although blended payment models show promise, evidence for the effectiveness of models including P4P is highly variable. If adopted, careful evaluation of each incentive's impact on both quality and equity will be essential.
31 May 2026
Read appraisal →Philosophical transactions. Series A, Mathematical, physical, and engineering sciences
Cognitive glues are shared models of relative scarcities: the economics of collective intelligence
Collective intelligence has emergent problem-solving capacities that are different than those of its subunits. The plethora of multi-scale systems within nature and society makes it imperative to understand the interaction policies necessary and sufficient for emergence of collective intelligences. The economy is a complex system consisting of autonomous elements at multiple scales and which exhibits adaptive problem-solving capabilities, suggesting that the economy offers an interesting, important example of collective intelligence. We identify the price system as the cognitive glue of the economy by acting as a coordinating affordance that enables members to form plans that are mutually compatible. Using the collective intelligence framework of Technological Approach to Mind Everywhere, we elaborate on various aspects of the economy that make it useful to model the economy as a collective intelligence. We argue that any cognitive glue must solve the same kind of problem that the price system solves in broadly the same way that the price system solves it, and thus the price system serves as a generic template or abstract model for all cognitive glues. Finally, we describe some research ideas that combine concepts from biology and economics in the hopes of inspiring interdisciplinary collaboration. This article is part of the theme issue 'World models in natural and artificial intelligence'.
15 May 2026
Read appraisal →