Record rewards: the effects of targeted quality incentives on the recording of risk factors by primary care providers

Financial incentives may increase performance oil targeted activities and have unintended consequences for untargeted activities. An innovative pay-for-performance scheme was introduced for UK general practices in 2004. It incentivised particular quality indicators for targeted groups of patients. We estimate the intended and unintended consequences of this Quality and Outcomes Framework (QOF) using dynamic panel probit models estimated oil individual patient records from 315 general practices over the period 2000/1-2005/6. We focus oil annual rates of recording of blood pressure, smoking status, cholesterol, body mass index and alcohol consumption. The recording of each risk factor is designated as incentivised or unincentivised for each individual based oil whether they have one of the diseases targeted by the QOF. The effect on incentivised factors was substantially larger oil the targeted patient groups (+19.9 percentage points) than on the untargeted groups (+5.3 percentage points). There was no obvious evidence of effort diversion but there was evidence Of Substantial positive spillovers (+10.9 percentage points) onto unincentivised Factors for the targeted groups. Moreover, provider responses were larger on those indicators for which more stringent standards were set and greater rewards offered. We conclude that the incentives induced providers to improve targeted quality and make investments ill quality that extended beyond the scheme. We estimate that the average provider was paid 20 pound 500 for recording 410 additional items of information oil the risk factors targeted by the financial incentives. Allowance for the positive spillovers reduces the estimated average reward from 50 pound to 25 pound per additional record. Copyright (C) 2009 John Wiley & Sons, Ltd.