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Using financial incentives to improve quality
Rewarding results: using financial incentives to improve quality
  1. M Marshall1,
  2. P Smith2
  1. 1National Primary Care Research and Development Centre, University of Manchester, UK
  2. 2Centre for Health Economics, University of York, UK
  1. Correspondence to:
 Professor Martin Marshall
 The University of Manchester, National Primary Care Research & Development Centre, 5th Floor Williamson Building, Oxford Road, Manchester M13 9PL, UK;

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Financial incentives are soon to be introduced into UK general practice to encourage quality improvement

Policy makers like to experiment with different ways of improving quality. Educational approaches have been dominant in the past. These are usually professionally led and developmental in nature. While they will always play an important role, the evidence that traditional educational methods do not seem to deliver an acceptable level or pace of change1 has come as a surprise to many people. Market based approaches, which rely on the informed consumer or purchaser selectively choosing high quality providers, have also had a disappointing impact on quality.2 In part this reflects the lack of real choice and the inadequacy of current sources of data to inform decision making. In a search for an alternative solution, policy makers in some countries have turned to performance management as a lever for change and, more specifically, are examining the use of financial incentives to reward measured performance.

Perhaps the most ambitious and innovative programme to encourage quality improvement is about to be implemented in general practice in the UK. Most British family doctors are not state employees but earn a large proportion of their income from capitation payments under contract with the National Health Service. This rewards general practitioners (GPs) mainly for having a large list of registered patients, but hardly at all for the quality of care that they provide for these patients. GPs were unhappy with their old contract and demanded change.3 Protracted negotiations between representatives of the profession and the …

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