The effect of financial incentives on the quality of health care provided by primary care physicians

Scott, Anthony; Peter, Sivey; Ouakrim, Driss Ait; Willenberg, Lisa; Naccerella, Lucio; Furler, John; Young, Doris

doi:10.1002/14651858.cd008451

Cited by 95 publications

(131 citation statements)

References 11 publications

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“…Financial incentives in primary care tend to have modest effects on relatively simple clinical behaviours such as risk factor recording or test ordering 12. The nature of targeted clinical behaviours is likely to influence the effectiveness of incentives 29 30.…”

Section: Discussionmentioning

confidence: 99%

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The effects of financial incentives for case finding for depression in patients with diabetes and coronary heart disease: interrupted time series analysis

et al. 2014

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ObjectiveTo evaluate the effects of Quality and Outcomes Framework (QOF) incentivised case finding for depression on diagnosis and treatment in targeted and non-targeted long-term conditions.DesignInterrupted time series analysis.SettingGeneral practices in Leeds, UK.Participants65 (58%) of 112 general practices shared data on 37 229 patients with diabetes and coronary heart disease targeted by case finding incentives, and 101 008 patients with four other long-term conditions not targeted (hypertension, epilepsy, chronic obstructive pulmonary disease and asthma).InterventionIncentivised case finding for depression using two standard screening questions.Main outcome measuresClinical codes indicating new depression-related diagnoses and new prescriptions of antidepressants. We extracted routinely recorded data from February 2002 through April 2012. The number of new diagnoses and prescriptions for those on registers was modelled with a binomial regression, which provided the strength of associations between time periods and their rates.ResultsNew diagnoses of depression increased from 21 to 94/100 000 per month in targeted patients between the periods 2002–2004 and 2007–2011 (OR 2.09; 1.92 to 2.27). The rate increased from 27 to 77/100 000 per month in non-targeted patients (OR 1.53; 1.46 to 1.62). The slopes in prescribing for both groups flattened to zero immediately after QOF was introduced but before incentivised case finding (p<0.01 for both). Antidepressant prescribing in targeted patients returned to the pre-QOF secular upward trend (Wald test for equivalence of slope, z=0.73, p=0.47); the slope was less steep for non-targeted patients (z=−4.14, p<0.01).ConclusionsIncentivised case finding increased new depression-related diagnoses. The establishment of QOF disrupted rising trends in new prescriptions of antidepressants, which resumed following the introduction of incentivised case finding. Prescribing trends are of concern given that they may include people with mild-to-moderate depression unlikely to respond to such treatment.

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Section: Discussionmentioning

confidence: 99%

“…The effectiveness of financial incentives in changing clinical behaviour is limited12 and pay-for-performance schemes often have unintended adverse consequences 13. More specifically, a systematic review concluded that advances in quality of care for long-term conditions included in UK QOF were modest 14.…”

Section: Introductionmentioning

confidence: 99%

The effects of financial incentives for case finding for depression in patients with diabetes and coronary heart disease: interrupted time series analysis

et al. 2014

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“…Multiple programmes have been implemented across a range of settings, but clear evidence for improved patient outcomes is yet to emerge. [10][11][12] In the United Kingdom a national primary care incentive scheme was introduced in 2004. The Quality and Outcomes Framework (QOF), one of largest pay-for-performance programmes in the world, links up to 25% of family practitioners' income to performance on over 100 publicly reported quality indicators.…”

Section: Introductionmentioning

confidence: 99%

Investigating the relationship between quality of primary care and premature mortality in England: a spatial whole-population study

Kontopantelis

Springate

Ashworth

et al. 2015

BMJ

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Objectives To quantify the relationship between a national primary care pay-for-performance programme, the UK's Quality and Outcomes Framework (QOF), and all-cause and cause-specific premature mortality linked closely with conditions included in the framework.Design Longitudinal spatial study, at the level of the "lower layer super output area" (LSOA).Setting 32482 LSOAs (neighbourhoods of 1500 people on average), covering the whole population of England (approximately 53.5 million), from 2007 to 2012.Participants 8647 English general practices participating in the QOF for at least one year of the study period, including over 99% of patients registered with primary care.Intervention National pay-for-performance programme incentivising performance on over 100 quality-of-care indicators.Main outcome measures All-cause and cause-specific mortality rates for six chronic conditions: diabetes, heart failure, hypertension, ischaemic heart disease, stroke, and chronic kidney disease. We used multiple linear regressions to investigate the relationship between spatially estimated recorded quality of care and mortality.Results All-cause and cause-specific mortality rates declined over the study period. Higher mortality was associated with greater area deprivation, urban location, and higher proportion of a non-white population. In general, there was no significant relationship between practice performance on quality indicators included in the QOF and all-cause or cause-specific mortality rates in the practice locality. ConclusionsHigher reported achievement of activities incentivised under a major, nationwide pay-for-performance programme did not seem to result in reduced incidence of premature death in the population. IntroductionPrimary care has enormous potential to improve population health outcomes-including mortality from common chronic conditions-through early intervention in the disease process 1 2 and coordinated provision of care. Effective primary care is associated with reduced morbidity, increased longevity, and more equitable health outcomes, 3 4 but quality of primary care varies widely between providers.5 6 Traditional physician payment systems have facilitated this variation, with fee-for-service systems potentially incentivising over-investigation and over-treatment, and capitation systems potentially incentivising under-utilisation. Neither approach directly rewards high quality care or investment in quality improvement. [7][8][9] In order to improve patient outcomes, policymakers worldwide have attempted to link remuneration for providers to quality of care through pay-for-performance programmes. Multiple programmes have been implemented across a range of settings, but clear evidence for improved patient outcomes is yet to emerge. [10][11][12] In the United Kingdom a national primary care incentive scheme was introduced in 2004. The Quality and Outcomes Framework (QOF), one of largest pay-for-performance programmes in the world, links up to 25% of family practitioners' income to performance on o...

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“…Like many pay-for-performance schemes, QOF’s effect on patient outcomes has been modest 1011. It has substantially altered how care in general practice is organised and delivered but, longer term, strategies for high quality primary care will need to evolve beyond QOF 12.…”

Section: Challengesmentioning

confidence: 99%

Quality and Outcomes Framework at the fork in the road

Raleigh

2018

BMJ

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The effect of financial incentives on the quality of health care provided by primary care physicians

Cited by 95 publications

References 11 publications

The effects of financial incentives for case finding for depression in patients with diabetes and coronary heart disease: interrupted time series analysis

The effects of financial incentives for case finding for depression in patients with diabetes and coronary heart disease: interrupted time series analysis

Investigating the relationship between quality of primary care and premature mortality in England: a spatial whole-population study

Quality and Outcomes Framework at the fork in the road

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