Incentives Negatively Impact Non-Incentivized Activities

Achievement rates lower in non-incentivized activities of quality of care in the longer-term

WEDNESDAY, June 29 (HealthDay News) -- Incentives may have a detrimental impact on non-incentivized activities of quality of care in the long-term, according to a study published online June 28 in BMJ.

Tim Doran, M.D., from the University of Manchester in the United Kingdom, and colleagues examined whether the incentive scheme for U.K. general practitioners led them to neglect activities that were not included in the scheme. Achievement rates for 42 activities, 23 of which were included in the scheme, were selected from 428 identified indicators of quality of care. Data were collected from 148 general practices in England, covering 653,500 patients. Trends in the pre-incentive period (2000-2001 to 2002-2003) and actual rates in the first three years of the scheme (2004-2005 to 2006-2007) were used to predict achievement rates.

The investigators found that, in the pre-incentive period, there was an improvement in achievement rates for most indicators. Twenty-two of the 23 incentivized indicators showed significant increases in the rate of improvement during the first year of the incentive scheme (2004 to 2005), and subsequently leveled off. In 2006 to 2007, the quality of care for 14 incentivized indicators remained better than that predicted by pre-incentive trends. Non-incentivized indicators did not show any improvement in the first year of the scheme, and by 2006 to 2007, achievement rates were significantly lower than those predicted by pre-incentive trends.

"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 incentivized," the authors write.

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