Financial inducements and patient care

Does offering financial inducements to GPs improve the care of patients?

Payments to Australian GPs are no longer limited to consultation fees. Other countries also offer incentive payments to GPs who carry out specific activities. Australian reviewers have therefore assessed the effect of these payments on the quality of care.

The reviewers searched for randomised trials, time-series analyses, and before and after studies. Only seven studies were suitable for the review and most of these had a substantial risk of bias.

Five studies were from the USA and involved incentives offered by private healthcare plans. Some schemes reduced payments to practices and then used the pool of money to pay bonuses to the better performers.

Three trials studied incentives for doctors to help patients quit smoking. Payments increased referral rates and the recording of patients’ smoking habits, but had no significant effect on smoking cessation.

The effects of payments on screening and diabetes care were examined in three studies. While incentives improved cervical screening rates and eye examinations, they had no significant effect on mammography and HbA1c testing.

A UK study looked at what happened when GPs were switched to salaried contracts. They were then assessed by surveys of their patients. The quality of care offered by the salaried doctors was no better than that of other GPs.

Although the use of ‘blended payments’ is increasing there is little evidence that this improves the performance of GPs.

The reviewers recommended that incentive schemes be more carefully designed before they are implemented.

Dr John Dowden