CHP Seminar: 27th November 2018 – The marginal patient: who no longer receives care when financial incentives are removed?

12.30-1.30pm Tuesday 27th November 2018
Room 410, Level 4, 207 Bouverie Street, Carlton

Presenter: Dr Rachel Meacock – Senior Lecturer in Health Economics at The University of Manchester, UK. 

Financial incentive schemes are generally associated with increases in the provision of incentivised care in the short-term, but recent evidence suggests that care provision quickly declines once these incentives are removed. Little is known about which types of patients no longer receive care once incentives are removed.

We study incentive removal from the long-running UK Quality and Outcomes Framework (QOF). Doctors have claimed the scheme distorts clinical decision-making and induces them to provide care to patients that did not need it. Therefore, we expect to see care no longer provided to patients for whom indicators were unnecessary or inappropriate.

Using a large, representative patient-level dataset, we examine whether patient gender, age, deprivation, frailty and co-morbidity are associated with no longer receiving care once financial incentives were removed for five health conditions. Achievement drops by approximately 10% when the incentives are removed. We find small differences by gender and age for some indicators, but the effects of removal are largely indiscriminate.

We consider the implications for clinical decision-making, equity and the success of pay-for-performance schemes.

For more details please view the event flyer.

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