Pay-for-performance incentives in the United Kingdom have not helped improve patients’ diabetes care, and the incentives may have led to reduced care for some diabetics, according to a study in the British Medical Journal.
Britain’s pay-for-performance program for all primary-care physicians, launched in 2004, is closely watched in the United States as a possible model to incentivize physicians to reduce costs and improve quality.
Researchers at the University of Birmingham and the University of Manchester in England looked at the proportion of patients meeting diabetes-care targets—including controlling glucose, blood pressure and cholesterol—between 2001 and 2007, before and after the nation’s pay-for-performance program began.
Analyzing data from 147 general practices covering more than 1 million patients across the U.K., the researchers found improvements in diabetes care and treatment, but these seemed to plateau after 2004, when the incentives kicked in. They speculate that the plateau may be a result of physicians reaching a ceiling, or upper threshold, of incentive payments for diabetes care.
The study also indicates that the incentive program is not helping eliminate health disparities. "The scheme in its present form fails to capture almost one-third of people in whom care may be suboptimal and may even lead to reduced levels of care for some groups of patients," wrote Melanie Calvert, senior lecturer at the Department of Primary Care and General Practice at the University of Birmingham, and lead author of the report.