This week, news published an article about Unilabs’ bonus system. In the article, it emerges that radiologists who have made fatal mistakes have themselves singled out tough production requirements as a stressful factor. Professor Gaute Torsvik at the University of Oslo (UiO) has long researched performance pay and bonus systems in working life, but was not aware that such incentives existed in the Norwegian healthcare system. – I would be careful about using a bonus in this type of work, says Torsvik. Professor Gaute Torsvik at the University of Oslo. Photo: Helle Westrum Can have a negative effect when quality is important The professor says that bonus incentives can have positive effects in businesses with simple tasks and routine work, where there are few other sources of motivation than the salary. But in cases where good quality is an important dimension, bonuses can have negative effects. – If the work tasks are more complex, bonus schemes can clearly lead to employees leaning towards what gives the highest bonus. This can lead to them ignoring other important aspects of the work task that are difficult to measure and reward, says Torsvik. For each examination the radiologists in Unilab examine, they accumulate so-called “X-ray points”. An MRI examination of the abdomen, for example, gives 2.75 points, while an MRI examination of the heart gives six points. Unilabs expects the radiologists to accumulate at least 112.5 X-ray points every day. Unilabs has X-ray institutes in several places in the country. Here from Majorstua in Oslo. Photo: Ronald Hole Fossåskaret / Ronald Hole Fossåskaret In the article “When the doctors get a bonus” we get an insight into widower Carl Otto Ingebretsen’s battle in court against Unilabs. The group’s bonus system was central there. But the district court emphasized the Unilabs radiologist’s explanation that he had not received much in bonus. It turned out to be completely wrong. However, according to UiO professor Torsvik, it is not essential that employees achieve the bonus requirement and receive payment for it to have an impact on their work. – Just the fact that there is a bonus scheme will make employees adjust to it. And then it can be even worse if he or she is just below the limit for receiving a bonus, says the professor. The competitor also has a bonus system In Norway, there are two large private X-ray companies that win almost all public tenders in the healthcare system: Unilabs and Evidia. Evidia, formerly known as Aleris Røntgen and Curato Røntgen, examines around 600,000 examinations annually. Evidia’s managing director Arvid Austgulen writes in an e-mail to news that they also have a bonus scheme for the radiologists. Unlike Unilabs, the Evidia radiologists do not have a set production requirement. According to Austgulen, only a small number of the radiologists receive a bonus each month. – The bonus scheme benefits those with very good specialist skills and long experience, as well as those who are focused on using as much of their working time as possible for radiological examination, and those who want to work something beyond normal working hours, writes Austgulen. Arvid Austgulen, CEO of the X-ray company Evidia. Photo: Evidia Evidia also has a system where the radiologists receive X-ray points based on how complicated the tasks are. The Evidia director writes that the management has full confidence in the radiologists, and that they are therefore not worried that the quality of the work will give way to bonus achievement. – We have 15 years’ experience with the bonus system we have today, and the experience indicates that we can be confident that this does not go beyond professional quality, writes Austgulen. He also says that Evidia’s bonus system has never been the subject of any appeals, supervisory proceedings or court proceedings. The health authorities: – We are informed that Health South-East is among the clients of Unilabs and Evidia in the public sector. – We have been aware that Unilabs has had a bonus scheme, says department director Lars Eikvar. These arrangements have also been examined in a group audit carried out by Helse Sør-Øst, points out Eikvar. The background was several serious deviations at Unilabs in Hamar. According to Eikvar, the report concluded that there was no basis for claiming that the quality failure at Hamar was connected to Unilabs’ incentive scheme. Lars Eikvar, department director in Health South-East. Photo: Katarina Theis-Haugan news has not been given access to this report. Helse Vest is also aware of the bonus schemes. Subject director Bjørn Egil Vikse says in a short comment to news that they are following along. – We are informed that there is a bonus scheme and that this has been changed. We feel in our dialogue now that Unilabs makes good judgments in this, says Vikse. – Mixing shop and health Parliamentary politician for the Labor Party, Cecilie Myrseth, believes that bonus schemes have nothing to do with the health system. – What is particularly bad about this case is how Unilabs mixes retail and health services. Because there is a difference between running a regular service, where you have to work quickly, and health services, she says. Cecilie Myrseth is health policy spokesperson for the Labor Party. Photo: Hanne Wilhelms / news Myrseth does not want a bonus ban, but believes the responsibility lies with the companies themselves. – We must be able to expect that there is a moral compass in the various companies, that they themselves take care to give the professionals the time they need to do a good job. Unilabs has been offered to express its views and respond to the allegations about its bonus system. However, medical head of radiology Christian Völker does not want to comment on the matter. – We find that our answers are edited to fit into their chosen story and that relevant facts are thus omitted. We therefore choose to refrain from further comments, writes Völker to news. Demand action from the government SV politician Marian Hussain believes that bonus incentives in the private healthcare system contribute to the erosion of the public healthcare system. She believes it is high time the government cleaned things up. – We are now in a situation where we are completely dependent on this type of player, says Hussain. Marian Hussein is SV’s health policy spokesperson. Photo: Nadir Alam / news The SV politician warns that she will ask the following questions in the Storting’s question time on the matter: “Does the minister agree that it is unfortunate that commercial actors make use of bonuses and other incentives which ultimately lead to the misdiagnosis of patients , and what measures will she introduce to ensure better control of, and reduced use of, actors such as Unilabs?” Labor politician Myrseth says the government is well underway with the “clean-up”. – Among other things, we have removed free choice of treatment and obtained professional input in order to be able to slow down the growth of private players where necessary, she says.
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Professor surprised by bonus schemes in the healthcare system – news Rogaland – Local news, TV and radio
