Financial incentives for doctors can improve the management of coronary heart disease (CHD) and reduce ethnic differences in quality of and access to care, according to Dr. Christopher Millett, Consultant in Public Health at Imperial College Faculty of Medicine in London in the UK, and his colleagues.
Their evaluation of the benefits of pay for performance schemes in the UK for the management of coronary heart disease, with a particular focus on ethnic differences, has just been published online in Springer's Journal of General Internal Medicine.
Pay for performance incentive schemes were introduced by the National Health Service in the UK in April 2004, to improve the quality of healthcare for all patients. The new family practitioner contract stated that 25 percent of a doctor's income would depend on performance against targets.
It is well documented that there are marked differences in cardiovascular disease prevalence and subsequent health outcomes between ethnic groups, as well as potential unequal access to high-quality care. The authors looked at whether financial incentives for doctors would address these differences in management of CHD across ethnic groups.
Millett and his team looked at electronic records from 32 family practices in inner city London, before and after the introduction of the new contract in 2004. They identified 2,891 people with CHD in 2003 and 3,101 in 2005 and examined 10 quality indicators for CHD management. There were incentives for recording smoking status, measuring cholesterol and blood pressure, prescribing aspirin, beta-blockers and ACE inhibitors, as well as for controlling cholesterol and blood pressure. There were no incentives for either BMI measurement or prescription of statins.