How Pay for Performance Affects Care in England

Two studies address staff attitudes and quality of care after incentives were initiated.

The use of financial incentives to induce increased attention to quality targets is growing in popularity, leading to these two observational studies from England, which initiated substantial financial incentives for quality in 2004.

One investigative team spent 5 months in 2004 directly observing and interviewing staff in two general practices (with 20,000 registered patients) and discerned three major themes. First, support for the goals of the financial incentives was broad. Second, an increased use of templates to collect data on care processes caused some apprehension among physicians and nurses. Third, the biggest area of concern was the increased use of internal monitoring of physician practices by colleagues, but little or no evidenc…

Reviewing Author

Keith I. Marton, MD