Do the incentive payments in the new NHS contract for primary care reflect likely population health gains?

摘要

Objective: The new contract for primary care in the UK ors fee-for-service (FFS) payments for a widenrange of activities in a quality outcomes framework (QOF), with payments designed to re￡ect likely workload.nThis study aims to explore the link between these ￠nancial incentives and the likely population healthngains.nMethods:The study examines a subset of eight preventive interventions covering 38 of the 81 clinical indicatorsnin the quality framework.Themaximumpayment for each service was calculated and comparedwithnthe likely population health gain in terms of lives saved per 100,000 population based on evidence fromnMcColl et al. (1998).nResults: Maximum payments for the eight interventions examined make up 57% of the total maximumnpayment for all clinical interventions in the (QOF). There appears to be no relationship between pay andnhealth gain across these eight interventions. Two of the eight interventions (warfarin in atrial ￠brillationnand statins in primary prevention) receive no incentive.nConclusions: Payments in the new contract do not re￡ect likely population health gain. There is a dangernthat clinical activity may be skewed towards high-workload activities that are only marginally ective, tonthe detriment of more cost-ective activities. If improving population health is the primary goal of thenNHS, then FFS incentives should be designed to re￡ect likely health gain rather than likely workload.