Objective:
The new contract for primary care in the UK offers fee-for-service payments for a
wide range of activities in a quality outcomes framework, with payments designed to reflect
likely workload. This study aims to explore the link between these financial incentives and the
likely population health gains.
Methods:
The study examines a subset of eight preventive interventions covering 38 of the
81 clinical indicators in the quality framework. The maximum payment for each service was
calculated and compared with the likely population health gain in terms of lives saved per
100,000 population based on evidence from McColl et al. (1998).
Results:
Maximum payments for the eight interventions examined make up 57% of the sum
total maximum payment for all clinical interventions in the quality outcomes framework. There
appears to be no relationship between pay and health gain across these eight interventions.
Two of the eight interventions (warfarin in atrial fibrillation and statins in primary prevention)
receive no incentive.
Conclusions:
Payments in the new contract do not reflect likely population health gain.
There is a danger that clinical activity may be skewed towards high-workload activities that
are only marginally effective, to the detriment of more cost effective activities. If improving
population health is the primary goal of the NHS, then fee-for-service incentives should be
designed to reflect likely health gain rather than likely workload
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