A study published on bmj.com today states that while the GP performance scheme in the UK has led to improvement in the quality of care; there have been small deleterious consequences on aspects of care that are non-incentivized.

The results of this study raise concern that financial incentive schemes can have possible unforeseen consequences and my even cause neglect of non-incentivized elements of patient care.

An incentive scheme termed Quality and Outcomes Framework (QOF) was formulated in 2004. This scheme, which receives an annual funding of £1bn (1.1bn euros; $1.6bn) from UK National Health Service, has linked one quarter of UK general practitioners’ income to performance based on a variety of quality indicators. In spite of the overwhelming support QOF receives, concerns are being raised whether such schemes are leading to unintentional consequences.

To answer this important healthcare question, scientists from the UK analyzed data from the General Practice Research Database (GPRD). GPRD is a repository of blinded patient data from over 500 UK general practices. The main aim of the study was to compare the changes in performance for indicators that had been incentivized to those that were not incentivized under this scheme. The researchers compared quality of care for a total of 42 activities (23 incentivized and 19 non-incentivized) prior to and after QOF was introduced in the UK.

The study results show that there was an overall improvement in the quality of care before the introduction of the financial incentives. For those activities that were incentivized, there was substantial improvement in the first year of the scheme. This improvement reached a steady state in the second and third year without any more improvements noticed by the researchers.

Although the introduction of the scheme did not have any effect on overall rate of improvement for activities that were not incentivized in the first year, there was a decline in quality by the third year that was considerably worse than what pre-incentive trends had projected. The authors attribute this to the practice of focusing on patients to whom incentives apply.

The authors conclude that financial incentive schemes could have important constraints, and such schemes need to be monitored for all activities irrespective of them being incentivized or not. They add that such monitoring will help us in understanding the implications of such schemes.

Link to Abstract

Written by Anne Hudsmith