ArticleBMC health services research2012
Incentive payments are not related to expected health gain in the pay for performance scheme for UK primary care: cross-sectional analysis.
Article in BMC health services research, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- What drives general practitioners in the UK to improve the quality of care? A systematic literature review.BMJ open quality · 2021Pooled it
- Design and effects of outcome-based payment models in healthcare: a systematic review.The European journal of health economics : HEPAC : health economics in prevention and care · 2019Pooled it
- Socioeconomic inequalities in the quality of care for long-term conditions in England: retrospective, observational study of electronic primary care records from the Clinical Practice Research Datalink.Journal of epidemiology and community health · 2026Observational
- Community participation and contracting between state and non-state actors in primary care: A scoping review of evidence.International journal for equity in health · 2025Article
- How slack resource affects hospital financial performance: The evidence from public hospitals in Beijing.Frontiers in public health · 2022Article
- A pay for performance scheme in primary care: Meta-synthesis of qualitative studies on the provider experiences of the quality and outcomes framework in the UK.BMC family practice · 2020Article
- Improving quality of care in general practices by self-audit, benchmarking and quality circles.Wiener klinische Wochenschrift · 2016Article
- How could the quality and outcomes framework (QOF) do more to tackle health inequalities?London journal of primary care · 2016Article
- Do Health Care Delivery System Reforms Improve Value? The Jury Is Still Out.Medical care · 2016Review
- 'Patient activation' as an outcome measure for primary care?Family practice · 2015Article
- Compliance with quality prescribing indicators linked to financial incentives: what about not incentivized indicators?: an observational study.European journal of clinical pharmacology · 2014Observational
- Compliance with quality prescribing indicators in terms of their relationship to financial incentives.European journal of clinical pharmacology · 2013Article
- Thirty-day complications after laparoscopic or open cholecystectomy: a population-based cohort study in Italy.BMJ open · 2013Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe General Medical Services primary care contract for the United Kingdom financially rewards performance in 19 clinical areas, through the Quality and Outcomes Framework. Little is known about how best to determine the size of financial incentives in pay for performance schemes. Our aim was to test the hypothesis that performance indicators with larger population health benefits receive larger financial incentives.
methodsWe performed cross sectional analyses to quantify associations between the size of financial incentives and expected health gain in the 2004 and 2006 versions of the Quality and Outcomes Framework. We used non-parametric two-sided Spearman rank correlation tests. Health gain was measured in expected lives saved in one year and in quality adjusted life years. For each quality indicator in an average sized general practice we tested for associations first, between the marginal increase in payment and the health gain resulting from a one percent point improvement in performance and second, between total payment and the health gain at the performance threshold for maximum payment.
resultsEvidence for lives saved or quality adjusted life years gained was found for 28 indicators accounting for 41% of the total incentive payments. No statistically significant associations were found between the expected health gain and incentive gained from a marginal 1% increase in performance in either the 2004 or 2006 version of the Quality and Outcomes Framework. In addition no associations were found between the size of financial payment for achievement of an indicator and the expected health gain at the performance threshold for maximum payment measured in lives saved or quality adjusted life years.
conclusionsIn this subgroup of indicators the financial incentives were not aligned to maximise health gain. This disconnection between incentive and expected health gain risks supporting clinical activities that are only marginally effective, at the expense of more effective activities receiving lower incentives. When designing pay for performance programmes decisions about the size of the financial incentive attached to an indicator should be informed by information on the health gain to be expected from that indicator.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.