Payments Can Reduce Inequalities in Health Care

August 12, 2008

Financial incentive schemes that pay general practices for their performance can help reduce inequalities in the delivery of health care between affluent and poor areas, according to a report published online Aug. 12 in The Lancet.

TUESDAY, Aug. 12 (HealthDay News) -- Financial incentive schemes that pay general practices for their performance can help reduce inequalities in the delivery of health care between affluent and poor areas, according to a report published online Aug. 12 in The Lancet.

Tim Doran, M.D., of the University of Manchester in the United Kingdom, and colleagues analyzed data from 7,637 general practices in England. They grouped the practices into quintiles based on the level of deprivation in their area. The researchers calculated overall levels of achievement for 48 clinical activity indicators for the first three years (2004-2005 to 2006-2007) of a financial incentive scheme that pays U.K. general practices for their performance against a set of quality indicators.

Median overall achievement was 85.1 percent in the first year, 89.3 percent in the second year and 90.8 percent in the third year, the researchers report. In the first year, median achievement ranged from 86.8 percent for the least deprived quintile to 82.8 percent for the most deprived, but by the third year the gap in median achievement had declined from 4 percent to 0.8 percent. The increase in achievement during the study was inversely associated with practice performance in previous years but not associated with area deprivation, the report indicates.

The author of an accompanying editorial writes: "We cannot afford to rest on our laurels with the quality and outcomes framework or other similar schemes. They are expensive and we need to know if they reduce suffering and inequities in suffering. There are now many indicators that we can apply."

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