In several countries, financial incentives to reward primary care practitioners who enhance the quality of their services is on the rise. After examining all available data in a Cochrane Systematic Review, a team of investigators discovered there was not enough evidence to either support or refute the practice. The researchers concluded policymakers need to proceed with caution prior to setting up an incentive scheme and that they should think very carefully about the way the scheme is designed.
The USA, UK, Australia and other countries have all deliberately devised hundreds of different incentive pay-scales for doctors who provide services, in order to attempt to change the way they work.
The investigators, led by Professor Anthony Scott and Dr Peter Sivey from the University of Melbourne’s Melbourne Institute of Applied Economic and Social Research in Australia, looked for investigations that had evaluated how effective such incentive schemes worked in practice. Even though these schemes had a lot of popularity, the researchers only found seven appropriate reports, looking at very different schemes.
Sivey explained:
“In particular, none of the studies addressed the ability of primary care physicians to opt into or out of the incentive scheme or health plan.”
The seven investigations looked at interventions covering a large variety of health-related issues, such as smoking cessation, assessment of the quality of care, cervical screening, mammography screening, diabetes, childhood immunization, chlamydia screening, and appropriate asthma medication.
Sivey says:
“There is currently little rigorous evidence about whether financial incentives do improve the quality of primary health care, or of whether such an approach is cost-effective relative to other ways of improving the quality of care.
There are ways of conducting high quality research that could find solid answers, and it is really important that we start collecting data that will address this critical issue.”
Written by Grace Rattue