Effect of financial incentives on inequalities in the delivery of primary clinical care in England: analysis of clinical activity indicators for the quality and outcomes framework
- PMID: 18701159
- DOI: 10.1016/S0140-6736(08)61123-X
Effect of financial incentives on inequalities in the delivery of primary clinical care in England: analysis of clinical activity indicators for the quality and outcomes framework
Abstract
Background: The quality and outcomes framework is a financial incentive scheme that remunerates general practices in the UK for their performance against a set of quality indicators. Incentive schemes can increase inequalities in the delivery of care if practices in affluent areas are more able to respond to the incentives than are those in deprived areas. We examined the relation between socioeconomic inequalities and delivered quality of clinical care in the first 3 years of this scheme.
Methods: We analysed data extracted automatically from clinical computing systems for 7637 general practices in England, data from the UK census, and data for characteristics of practices and patients from the 2006 general medical statistics database. Practices were grouped into equal-sized quintiles on the basis of area deprivation in their locality. We calculated overall levels of achievement, defined as the proportion of patients who were deemed eligible by the practices for whom the targets were achieved, for 48 clinical activity indicators during the first 3 years of the incentive scheme (from 2004-05 to 2006-07).
Findings: Median overall reported achievement was 85.1% (IQR 79.0-89.1) in year 1, 89.3% (86.0-91.5) in year 2, and 90.8% (88.5-92.6) in year 3. In year 1, area deprivation was associated with lower levels of achievement, with median achievement ranging from 86.8% (82.2-89.6) for quintile 1 (least deprived) to 82.8% (75.2-87.8) for quintile 5 (most deprived). Between years 1 and 3, median achievement increased by 4.4% for quintile 1 and by 7.6% for quintile 5, and the gap in median achievement narrowed from 4.0% to 0.8% during this period. Increase in achievement during this time was inversely associated with practice performance in previous years (p<0.0001), but was not associated with area deprivation (p=0.062).
Interpretation: Our results suggest that financial incentive schemes have the potential to make a substantial contribution to the reduction of inequalities in the delivery of clinical care related to area deprivation.
Comment in
-
Quality and outcomes framework: patient-centred?Lancet. 2008 Aug 30;372(9640):692-4. doi: 10.1016/S0140-6736(08)61124-1. Epub 2008 Aug 11. Lancet. 2008. PMID: 18701158 No abstract available.
Similar articles
-
Does a local financial incentive scheme reduce inequalities in the delivery of clinical care in a socially deprived community? A longitudinal data analysis.BMC Fam Pract. 2015 May 14;16:61. doi: 10.1186/s12875-015-0279-9. BMC Fam Pract. 2015. PMID: 25971774 Free PMC article.
-
Incentive payments are not related to expected health gain in the pay for performance scheme for UK primary care: cross-sectional analysis.BMC Health Serv Res. 2012 Apr 16;12:94. doi: 10.1186/1472-6963-12-94. BMC Health Serv Res. 2012. PMID: 22507660 Free PMC article.
-
Pay-for-performance programs in family practices in the United Kingdom.N Engl J Med. 2006 Jul 27;355(4):375-84. doi: 10.1056/NEJMsa055505. N Engl J Med. 2006. PMID: 16870916
-
The association between quality of primary care, deprivation and cardiovascular outcomes: a cross-sectional study using data from the UK Quality and Outcomes Framework.J Epidemiol Community Health. 2010 Oct;64(10):927-34. doi: 10.1136/jech.2009.098806. Epub 2010 Sep 6. J Epidemiol Community Health. 2010. PMID: 20820055
-
Effect of social deprivation on blood pressure monitoring and control in England: a survey of data from the quality and outcomes framework.BMJ. 2008 Oct 28;337:a2030. doi: 10.1136/bmj.a2030. BMJ. 2008. PMID: 18957697 Free PMC article.
Cited by
-
How to pay primary care physicians for SARS-CoV-2 vaccinations: An analysis of 43 EU and OECD countries.Health Policy. 2022 Jun;126(6):485-492. doi: 10.1016/j.healthpol.2022.03.008. Epub 2022 Mar 20. Health Policy. 2022. PMID: 35367056 Free PMC article.
-
Who is paid in pay-for-performance? Inequalities in the distribution of financial bonuses amongst health centres in Zimbabwe.Health Policy Plan. 2022 Apr 13;37(4):429-439. doi: 10.1093/heapol/czab154. Health Policy Plan. 2022. PMID: 35090018 Free PMC article.
-
Inequalities in glycemic management in people living with type 2 diabetes mellitus and severe mental illnesses: cohort study from the UK over 10 years.BMJ Open Diabetes Res Care. 2021 Sep;9(1):e002118. doi: 10.1136/bmjdrc-2021-002118. BMJ Open Diabetes Res Care. 2021. PMID: 34497046 Free PMC article.
-
Evaluating the Effectiveness of a Local Primary Care Incentive Scheme: A Difference-in-Differences Study.Med Care Res Rev. 2022 Jun;79(3):394-403. doi: 10.1177/10775587211035280. Epub 2021 Jul 29. Med Care Res Rev. 2022. PMID: 34323143 Free PMC article.
-
Socioeconomic inequalities in the quality of primary care under Brazil's national pay-for-performance programme: a longitudinal study of family health teams.Lancet Glob Health. 2021 Mar;9(3):e331-e339. doi: 10.1016/S2214-109X(20)30480-0. Lancet Glob Health. 2021. PMID: 33607031 Free PMC article.
MeSH terms
LinkOut - more resources
Full Text Sources
Miscellaneous
