Do 'payments for performance' lead to better or lower quality of services in public service healthcare?

摘要

With an increasing emphasis placed on stakeholder value, there has been a growing need to measure the performance of UK public sector healthcare services. Introduced in 2004 but considerably changed since, the quality and outcomes framework (QOF) sought to measure the performance of general practitioners against a variety of clinical, professional, and patient domains. A literature search was performed using MEDLINE, PubMed, and Google Scholar; revealing that, through QOF indicators and hospital admission rates, clinical care has improved, yet conflicting evidence makes an equivocal statement difficult. Further evidence showed narrowing health inequalities and an improvement in chronic indicators. Other reviewed domains showed a tendency to game the system, while the demands of QOF may go against a desire for holism. Such findings seem to suggest that QOF is something of a double-edged sword. On hard data, such as clinical indicators, QOF is undoubtedly a beneficial system that has raised standards of care; however, on a softer and more personal level, QOF appears to contribute to a decline in patient-centeredness and encourage a gaming culture that goes against professional values. Therefore, QOF must be adapted and improved to tackle these issues to further improve on its core aims.