Financial incentives have been shown to be an effective way to boost clinical performance, but when those monetary rewards are removed, quality suffers. That was the troubling conclusion of British researchers who collaborated with California-based Kaiser Permanente on a new longitudinal study published online by the British Medical Journal, which looks at before-and-after rates of performance.
Quality suffers when incentives end, study finds
In the study, researchers examined four quality indicators used by Kaiser—diabetes retinopathy screening, cervical cancer screening, glycemic control for diabetes and hypertension control—and found that performance at 35 Kaiser facilities faltered when incentives were pulled.
For instance, during a five-year period when financial rewards were attached to diabetes retinopathy screening, rates increased from 84.9% to 88.1%. In the four years after incentives were removed, however, screening rates dropped to 80.5%.
Rates of cervical cancer screening also rose somewhat when the procedure was incentivized. However, when those rewards were removed, screening rates fell, prompting Kaiser to reinstate the payments.
Those results are of particular worry in the U.K., where incentive payments set up for performance on eight quality indicators are set to expire next year.
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