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Cited by 258Primary Care and Health OutcomesHealthcare Policy and ManagementHealth Services Management and Policy

Effect of financial incentives on incentivised and non-incentivised clinical activities: longitudinal analysis of data from the UK Quality and Outcomes Framework

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Doran, T., Kontopantelis, E., Valderas, J. M., Campbell, S., Roland, M., Salisbury, C., Reeves, D.·2011·BMJ
DOI 10.1136/bmj.d3590PMC PMC3125475
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Abstract

OBJECTIVE: To investigate whether the incentive scheme for UK general practitioners led them to neglect activities not included in the scheme. DESIGN: Longitudinal analysis of achievement rates for 42 activities (23 included in incentive scheme, 19 not included) selected from 428 identified indicators of quality of care. SETTING: 148 general practices in England (653 500 patients). MAIN OUTCOME MEASURES: Achievement rates projected from trends in the pre-incentive period (2000-1 to 2002-3) and actual rates in the first three years of the scheme (2004-5 to 2006-7). RESULTS: Achievement rates improved for most indicators in the pre-incentive period. There were significant increases in the rate of improvement in the first year of the incentive scheme (2004-5) for 22 of the 23 incentivised indicators. Achievement for these indicators reached a plateau after 2004-5, but quality of care in 2006-7 remained higher than that predicted by pre-incentive trends for 14 incentivised indicators. There was no overall effect on the rate of improvement for non-incentivised indicators in the first year of the scheme, but by 2006-7 achievement rates were significantly below those predicted by pre-incentive trends. CONCLUSIONS: There were substantial improvements in quality for all indicators between 2001 and 2007. Improvements associated with financial incentives seem to have been achieved at the expense of small detrimental effects on aspects of care that were not incentivised.

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  • Similar strategies to reduce the mortality gap have been employed in other countries, including the USA, Canada, Australia and throughout Europe.

    “Similar strategies have been employed in other countries, including the USA,18,19 Canada,20,21 Australia22–24 and throughout Europe.25,26”

    From Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000–2014 (2017) · cites this paper as [24]

    The Introduction (page not available) describes the UK Quality and Outcomes Framework, so the paper provides an example of a quality-improvement strategy used in Europe. It does not establish that similar strategies were employed throughout Europe, or that the UK scheme was intended to reduce a mortality gap. (LLM, conf=0.79)

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Research works printed but not linked: 3

  1. Roland M. Linking physician pay to quality of care: a major experiment in the UK. N Engl J Med 2004;351:1448-54.
  2. Doran T, Fullwood K, Kontopantelis E, Reeves D. The effect of financial incentives on inequalities in the delivery of primary care in England. Lancet 2008;372:728-36.
  3. Marshall M, Campbell S, Hacker J, Roland M, eds. Quality indicators for general practice: a practical guide to clinical quality indicators for primary care professionals and managers . Royal Society of Medicine Press, 2002.

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Authors
Doran, T., Kontopantelis, E., Valderas, J. M., Campbell, S., Roland, M., Salisbury, C., & Reeves, D.
Affiliations
  • University of Manchester (GB)
  • University of Oxford (GB)
  • University of Cambridge (GB)
  • University of Bristol (GB)
Corresponding author
Doran, T.
ORCID
Venue
BMJ
Publisher
BMJ
Published
2011-06-28
Volume
342
Issue
jun28 1
Pages
d3590-d3590
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.d3590
PMC
PMC3125475
OpenAlex
W2141725152
Cited by
258
References
26
Citations by year
2026: 6 · 2025: 7 · 2024: 9 · 2023: 9 · 2022: 6 · 2021: 10 · 2020: 14 · 2019: 18 · 2018: 18 · 2017: 33 · 2016: 25 · 2015: 27 · 2014: 22 · 2013: 26 · 2012: 22
FWCI
44.60
Type
journal article
Language
en
Update notices
correction (2013-10-02)
Open access
Licence
cc-by-nc
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (publishedVersion)
  • Bristol Research (University of Bristol) (publishedVersion)
  • Explore Bristol Research (submittedVersion, public-domain)
  • Figshare (submittedVersion)
  • HighWire Press Open Archive (submittedVersion)
  • Open Research Exeter (University of Exeter) (submittedVersion, cc-by-nc)
Funders
National Institute for Health and Care Research
Topics
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
  • Health Sciences › Health Professions › General Health Professions › Health Services Management and Policy
Keywords
financial incentives, Quality and Outcomes Framework, general practitioners, quality of care, quality indicators, primary care, unintended consequences, healthcare quality improvement, general practice
MeSH terms
Financing, Government, United Kingdom, Motivation, Quality of Health Care, Outcome Assessment, Health Care, General Practice

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