Details matter: Physician responses to multiple payments for the same activity

Area of Science:

• Health Services Research
• Health Economics
• General Practice

Background:

• The UK's Quality and Outcomes Framework (QOF) incentivizes general practices for chronic disease management quality indicators.
• Some QOF indicators are multi-rewarded (applying to patients with multiple conditions), while others are singly rewarded (for single conditions).

Purpose of the Study:

• To compare general practice performance on single versus multi-reward quality indicators within the QOF.
• To investigate how the structure of financial incentives affects physician behavior and patient outcomes in primary care.

Main Methods:

• Analysis of a 2005/6-2012/13 panel dataset of over 800 Scottish general practices.
• Statistical controls for practice characteristics, fixed effects, indicator attributes, patient conditions, and year.
• Exploitation of a policy change replacing multi-reward smoking indicators with single-reward ones in 2006/7.

Main Results:

• Multi-reward indicators demonstrated higher achievement proportions and lower exception reporting rates compared to single-reward indicators.
• Following the shift from multi-reward to single-reward smoking indicators, achievement rates for these indicators decreased.

Conclusions:

• The specific design of pay-for-performance schemes, particularly the reward structure of indicators, significantly influences physician behavior.
• These design details have tangible effects on the achievement of quality targets and potentially patient outcomes in chronic disease management.