The BMJ Today: More pay, better care?

debsDoes pay for performance improve health outcomes in certain chronic conditions? The UK has one of the largest schemes in the world—the Quality and Outcomes Framework—and, to date, evaluations have produced mixed results and uncertainties remain.

In a recently published research paper on, one international team carefully examine one aspect of pay for performance in healthcare—if QOF reduced emergency admissions for certain chronic conditions since the introduction of the scheme. Such ambulatory care sensitive conditions (ACSCs) are illnesses for which it is possible to prevent acute exacerbations and reduce the need for hospital admission through active management.

In some cases, care for these conditions are incentivised by QOF, others are not, and some conditions are not thought to be ambulatory care sensitive. So, in a large longitudinal study, the researchers compared the hospital admissions between the different groups in over 6000 family practices since the introduction of QOF, to see if pay for performance had had an impact.

While there were limitations to the study, they found it did. There was a “moderate” and “sustained” reduction in emergency hospital admissions for those conditions that were incentivised—particularly for coronary heart disease and stroke.

But is it as simple as more pay, better care? Both the researchers themselves and the authors of an accompanying editorial, suggest that the mechanism by which the reduction has occurred is uncertain. As the editorialists say, pay for performance is no more a “magic bullet” than any other quality improvement method.

Deborah Cohen is investigations editor for The BMJ.