(2008), "UK: Provider incentives report published", International Journal of Health Care Quality Assurance, Vol. 21 No. 5. https://doi.org/10.1108/ijhcqa.2008.06221eab.008
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Copyright © 2008, Emerald Group Publishing Limited
UK: Provider incentives report published
Article Type: News and views From: International Journal of Health Care Quality Assurance, Volume 21, Issue 5
Keywords: Healthcare outcomes, Quality improvements, Patient choice
The Health Foundation has published a new report from its Quest for Quality and Performance (QQUIP) entitled: “Financial incentives, healthcare providers and quality improvements.”
The report is timely for the UK given the current debate between the government and GPs about the most effective way of paying GPs and what the public is seeking from general practice services. Much of the evidence examined in the report is gathered from the US. Martin Roland, Director of the National Centre for Primary Care Research and Development has provided a commentary on the implications for the future use of incentives in the UK.
Evidence from the report suggests that the impact of financial incentives on outcomes of care (in contrast to processes of care) does not appear to be as strong as some have claimed. There is limited international evidence on the impact of financial incentives as a stand-alone measure to improve quality, though the evidence is growing at a rapid pace. It is therefore important to use incentives cautiously, to limit their size as a proportion of overall income and to carefully evaluate new initiatives. It is also clear that incentives should be used as part of a package to improve quality of care, alongside other approaches such as patient choice, commissioning and clinical audit. The way that they interact with other levers for change is as important as how they work in isolation.
The report also highlights that many of the areas targeted by incentives were areas that doctors were addressing already, making it fairly easy for them to achieve their targets. In many cases this meant that doctors were rewarded for what they were already doing, rather than incentives to improve. Incentive programmes also need to be better communicated so that people understand the nature and purpose of the financial incentives. This would maximise the chances of them responding positively.
Martin Roland argues in his commentary that the amount of incentive in the quality and outcomes framework (QOF) for GPs should “gradually reduce as a proportion of overall practice income” and questions how incentives would operate in hospitals. “Is it the managers or clinicians who are being incentivised?” he asks, “or individuals or teams?” Martin cautions “Hospitals are much more complex organisations than general practices, and those trying out such schemes need to think very clearly about how incentives might reasonably be expected to operate.”
For more information: www.health.org.uk