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Record rewards: the effects of targeted quality incentives on the recording of risk factors by primary care providers

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Author Info

  • Matt Sutton

    (Health Economics, Health Methodology Research Group, University of Manchester, Manchester, UK)

  • Ross Elder

    (NHSScotland National Services, Information Services Division, Edinburgh, UK)

  • Bruce Guthrie

    (Tayside Centre for General Practice, University of Dundee, Dundee, UK)

  • Graham Watt

    (General Practice and Primary Care, University of Glasgow, Glasgow, UK)

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    Abstract

    Financial incentives may increase performance on targeted activities and have unintended consequences for untargeted activities. An innovative pay-for-performance scheme was introduced for UK general practices in 2004. It incentivised particular quality indicators for targeted groups of patients. We estimate the intended and unintended consequences of this Quality and Outcomes Framework (QOF) using dynamic panel probit models estimated on individual patient records from 315 general practices over the period 2000|1-2005|6. We focus on annual rates of recording of blood pressure, smoking status, cholesterol, body mass index and alcohol consumption. The recording of each risk factor is designated as incentivised or unincentivised for each individual based on whether they have one of the diseases targeted by the QOF. The effect on incentivised factors was substantially larger on the targeted patient groups (+19.9 percentage points) than on the untargeted groups (+5.3 percentage points). There was no obvious evidence of effort diversion but there was evidence of substantial positive spillovers (+10.9 percentage points) onto unincentivised factors for the targeted groups. Moreover, provider responses were larger on those indicators for which more stringent standards were set and greater rewards offered. We conclude that the incentives induced providers to improve targeted quality and make investments in quality that extended beyond the scheme. We estimate that the average provider was paid £20 500 for recording 410 additional items of information on the risk factors targeted by the financial incentives. Allowance for the positive spillovers reduces the estimated average reward from £50 to £25 per additional record. Copyright © 2009 John Wiley & Sons, Ltd.

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    File URL: http://hdl.handle.net/10.1002/hec.1440
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    Bibliographic Info

    Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

    Volume (Year): 19 (2010)
    Issue (Month): 1 ()
    Pages: 1-13

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    Handle: RePEc:wly:hlthec:v:19:y:2010:i:1:p:1-13

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    Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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    References

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    Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
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    1. Paul Contoyannis & Andrew M. Jones & Nigel Rice, 2004. "The dynamics of health in the British Household Panel Survey," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 19(4), pages 473-503.
    2. Kelman, Steven & Friedman, John N., 2007. "Performance Improvement and Performance Dysfunction: An Empirical Examination of Impacts of the Emergency Room Wait-Time Target in the English National Health Service," Working Paper Series rwp07-034, Harvard University, John F. Kennedy School of Government.
    3. Hugh Gravelle & Matt Sutton & Ada Ma, 2008. "Doctor Behaviour Under a Pay for Performance Contract: Further Evidence from the Quality and Outcomes Framework," Working Papers 034cherp, Centre for Health Economics, University of York.
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    Cited by:
    1. Fiorentini, Gianluca & Lippi Bruni, Matteo & Ugolini, Cristina, 2013. "GPs and hospital expenditures. Should we keep expenditure containment programs alive?," Social Science & Medicine, Elsevier, vol. 82(C), pages 10-20.
    2. Iezzi, Elisa & Lippi Bruni, Matteo & Ugolini, Cristina, 2014. "The role of GP's compensation schemes in diabetes care: Evidence from panel data," Journal of Health Economics, Elsevier, vol. 34(C), pages 104-120.
    3. Kantarevic, Jasmin & Kralj, Boris & Weinkauf, Darrel, 2011. "Enhanced fee-for-service model and physician productivity: Evidence from Family Health Groups in Ontario," Journal of Health Economics, Elsevier, vol. 30(1), pages 99-111, January.
    4. Kristensen, Soren Rud & Bech, Mickael & Lauridsen, Jørgen T, 2013. "Who to pay for performance? The choice of organisational level for hospital performance incentives," COHERE Working Paper 2013:5, COHERE - Centre of Health Economics Research, University of Southern Denmark.
    5. Kantarevic, Jasmin & Kralj, Boris & Weinkauf, Darrel, 2010. "Enhanced Fee-for-Service Model and Access to Physician Services: Evidence from Family Health Groups in Ontario," IZA Discussion Papers 4862, Institute for the Study of Labor (IZA).

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