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Financial incentives and quality improvement

¹ Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
² University of Wales Bangor, Bangor LL57 2UW, UK

Correspondence to:
Dr A Rashidian
Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; arash.rashidian@lshtm.ac.uk

Keywords: financial incentives; internal motivation; general practice; quality improvement

The first 150 words of the full text of this article appear below.

We share Marshall and Harrison’s caution on over-reliance on financial incentives for improving quality of care manifested in the new UK general practice contract.¹ Financial incentives do not always result in behaviour change as intended for reasons that are not well understood. We argue that "the fascination with financial incentives" is not "based on sound empirical evidence".

In recent years at least three systematic reviews on the impact of financial incentives on provider behaviour have been published.^2–4 The reviews agree that good quality evidence is lacking and that the available research evidence provides mixed messages.^3,4 For example, a controlled before/after study of 426 Danish GPs assessed the effects of adding fee-for-service to capitation on the use of repeat prescription.⁵ Contrary to expectations, fee-for-service payments were associated with a fall in repeat prescription rates. Some suggested the findings either implied that GPs did not respond to financial incentives or the fee . . . [Full text of this article]