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In 2004, the U.K. introduced a pay-for-performance (P4P) program for family practices. Substantial payments are made for meeting 136 different indicators of high-quality care.
Researchers reviewed medical records in 42 representative practices for 2 years before the P4P system started (1998 and 2003) and for 2 years after it commenced (2005 and 2007). Quality scores increased annually for asthma, diabetes, and coronary heart disease during the pre-P4P evaluation period. Scores continued to rise, but more slowly, for asthma and diabetes in the post-P4P evaluation period; however, scores did not rise for coronary disease after P4P was instituted. Researchers noted no changes in patients' perception of access to care or of interpersonal aspects…