When incentive payments to doctors end, quality of medical care declines

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One of the best ways to improve the quality of medical care is to give doctors a financial stake in their health of their patients. Studies show that targeted monetary incentives prompt doctors to focus on specific clinical outcomes. But what happens when those incentives are removed?

British researchers wanted to know, since the government there is scheduled to stop making incentive payments based on eight indicators of clinical quality next year. So they teamed up with researchers from Kaiser Permanente to see what happened in Northern California when the health giant stopped rewarding doctors who screened patients for diabetic retinopathy and cervical cancer.


Between 1999 and 2003, when Kaiser physicians were rewarded for screening diabetic patients for diabetic retinopathy -- a complication that can cause severe vision loss, including blindness -- the screening rate rose from 84.9% to 88.1%. Then the incentive payments stopped, and the screening rate dropped to 80.5% four years later.

In the case of cervical cancer, screening rates ticked up from 77.4% to 78% between 1999 and 2000, when financial incentives were in place. Kaiser stopped the payments from 2001 through 2005, and during that time, the screening rate fell to 74.3%. That apparently caused Kaiser to reinstate the incentive payments, and the trend reversed over the next two years.

The study is being published online Wednesday by the British Medical Journal.

The results showed that doctors needed to find ways to maintain quality care for patients when financial incentives stopped, the researchers said. But that might be tricky, since it has been shown that once people get paid to do something, they’re less likely to do it for free.

-- Karen Kaplan