Blog | Friday, March 19, 2010

Does Pay for Performance Improve Health Care Quality?

This post by Evan Falchuk, JD, appeared at Better Health.

The Jobbing Doctor, a primary care doctor in the U.K., writes about the British version of what Americans call "Pay for Performance," or "P4P."

He says something I've said many times before (like here, here and here), which is this: Incentives fail because they try to treat medicine as an assembly line process when it's not.

But what's most interesting about his post is that it could have been written by a doctor from anyplace on the planet Earth.

The Jobbing Doctor talks about a U.K. program that started in 2004 called the Quality and Outcomes Framework, or "QoF." Now, the American "P4P" is a much more catchy name, so score one for American marketing. But it doesn't matter what you call it, that which we call a rose would, by any other name smell as sweet.

Or, as in this case, as sour.

According to the Jobbing Doctor, QoF has actually increased costs (or at least doctors' income; he says it went up 33%) because the government seemed to have underestimated the extent to which doctors were already delivering high quality primary care. He also notes that because the guidelines are so crude and so focused on certain illnesses, there are incentives to meet targets rather than understanding a patient's medical condition. It's pretty much the opposite of what doctors are taught to do in their training. And his complaints about QoF sound very similar to complaints from doctors in other countries about the impact of such well-meaning efforts by government and private industry.

Which is the larger point.

As Jobbing Doctor put it so eloquently, measures like these distort the practice of medicine and take it away from what is really important:

The other downside is that ideas like the QoF diminish a profession's values and judgments, meaning that high quality care is not driven by an internal motivation for doing a good and valuable job well, rather we have to be driven by targets. Targets are the antithesis of professionalism.

So, yes, the quality of medical care needs to improve. But how you define quality is the first question that must be answered. If I'm sick, I want my doctor motivated and paid to do "a good and valuable job well."

This post originally appeared on Better Health, a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.