The marginal patient: who no longer receives care when financial incentives are removed?

All events are on Tue 1:00 – 2:00 in the Worsley building

This week our presenter will be Dr Rachael Meacock from the University of Manchester

The marginal patient: who no longer receives care when financial incentives are removed?

Pay-for-performance schemes link financial payments by purchasers to the quality of care supplied by healthcare providers. The use of financial incentives as a mechanism for quality improvement is now commonplace across health systems globally. Whilst the impact of introducing financial incentives has been studied extensively, little is known about the consequences of removing financial incentives once they are in place. The overall benefits of pay-for-performance programmes will depend upon whether any resulting quality improvements represent permanent or transitory improvements.

We study incentive removal from the long-running UK Quality and Outcomes Framework (QOF), which links financial incentives to the quality of care provided by GPs in England. Doctors have claimed the scheme distorts clinical decision-making and induces them to provide care to patients that did not need it. Therefore, we expect to see care no longer provided to patients for whom indicators were unnecessary or inappropriate.

Overall achievement drops by approximately 10% when the incentives are removed. Using a large representative patient-level dataset, we examine whether patient gender, age, deprivation, and co-morbidity are associated with no longer receiving care once financial incentives were removed for four chronic health conditions.

We consider the implications of our findings for clinical decision-making, equity and the long-term success of pay-for-performance schemes.