ArticleThe British journal of general practice : the journal of the Royal College of General Practitioners1995
The carrot, the stick and the general practitioner: how have changes in financial incentives affected health promotion activity in general practice?
Article in The British journal of general practice : the journal of the Royal College of General Practitioners, 1995. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 2 of them syntheses that pooled it.
What it found
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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.
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Who cites it
10 citing papers in PubMed, 2 syntheses or guidelines pooled it, 24 citations in OpenAlex.
- Systematic review: Effects, design choices, and context of pay-for-performance in health care.BMC health services research · 2010Pooled it
- Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians.The Cochrane database of systematic reviews · 2000Pooled it
- Designing an effective pay-for-performance system in the Korean National Health Insurance.Journal of preventive medicine and public health = Yebang Uihakhoe chi · 2012Review
- A few lessons in screening for Gordon Brown.BMJ (Clinical research ed.) · 2008Article
- The new general practice contract and reform of primary care in the United kingdom.Healthcare policy = Politiques de sante · 2007Article
- Understanding general practice: a conceptual framework developed from case studies in the UK NHS.The British journal of general practice : the journal of the Royal College of General Practitioners · 2007Article
- Do single handed practices offer poorer care? Cross sectional survey of processes and outcomes.BMJ (Clinical research ed.) · 2001Article
- Can general practitioners influence the nation's health through a population approach to provision of lifestyle advice?The British journal of general practice : the journal of the Royal College of General Practitioners · 2000Article
- Measuring concentration in primary care.Health care management science · 2000Article
- Quality at general practice consultations: cross sectional survey.BMJ (Clinical research ed.) · 1999Article
Corrections and comments
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundFinancial incentives for increasing health promotion activity in primary care, introduced with the 1990 contract for general practitioners, were amended in 1993 and are now focused on cardiovascular disease. Payments for health promotion clinics were abolished and target payments were introduced.
aimThe study aimed to evaluate the effect of the change, in June 1993, in financial incentives for health promotion activity in primary care on the distribution of health promotion payments in two family health services authorities.
methodA retrospective study was undertaken in which data from two family health services authorities were used to determine the annual level of health promotion payments per 1000 practice population before and after the contractual amendment. Health promotion clinic payment data were analysed for 78 practices in Bedfordshire Family Health Services Authority and 85 practices in Kensington, Chelsea and Westminster Family Health Services Authority. Changes in health promotion payments were calculated and related to two measures of relative need: all cause standardized mortality ratios, for patients aged 74 years or less, of the electoral ward in which the practice is located; and the Jarman underprivileged area score. High relative need was defined as a standardized mortality ratio of over 100 or more than 25% of the practice population living in electoral wards with a Jarman score of over 30.
resultsHealth promotion payments were more evenly distributed after the change in June 1993 than before between the two family health services authorities and between general practices. Single-handed practices were carrying out more clinics in 1992 than multi-partner practices and consequently were one of the greatest financial losers as a result of the change. In addition, practices located in electoral wards with high relative needs lost proportionally more than those in electoral wards with lower needs.
conclusionChanges in the general practitioner health promotion contract have created new financial winners and losers. It now appears that health promotion payments are more evenly distributed but that the distribution is unrelated to need or treatment given. More evidence on the effectiveness of health promotion interventions is required before policies aimed at promoting better health through primary care can be fully evaluated.
Indexed as
Identifiers
8745865PMC1239470W97207459What 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.