Did pay for performance pay off in England?

A pay-for-performance (P4P) scheme based on meeting targets for the quality of clinical care introduced to family practice in England in 2004 accelerated improvements in quality for 2 of 3 chronic conditions in the short term. However, the initial acceleration in improvement was not sustained.

Campbell and coworkers analyzed the quality of health care in a group of 42 practices before and after a P4P system was started. They focused on care given to patients who had asthma, diabetes mellitus (DM), or heart disease and asked patients how they felt about access to and continuity of care.

The quality of care for asthma and DM, but not heart disease, increased during the first 2 years of the new system-a continuation of a trend that started before P4P was introduced. After this initial uptick, however, the rate of improvement slowed for all 3 conditions. Across all conditions, quality scores for care that was linked to incentives were higher than scores for care not linked to incentives.

The authors noted that patients’ perceptions of continuity of care declined right after the P4P scheme was introduced, but their opinions about access to care and interpersonal aspects of care remained unchanged.