Study: Cancellation of additional payments to doctors directly affects the quality of medical care

QOF provides financial incentives for doctors to implement effective solutions in their practice and to improve the quality of medical care according to specific criteria. The authors of the scientific article emphasized that the system initially included more than 150 criteria for the quality of medical care and formed 20-25% of the income of institutions providing primary medical care in the UK. Gradually, the number of criteria for funding was reduced in QOF, and the income of clinics tied to the program decreased. At the end of 2016, QOF was completely phased out in the Scottish health care system.

The authors decided to study the impact of the program on the quality of work of doctors in primary health care in the period from January 2004 to September 2024. To do this, they identified 3,495 thematic studies from the MEDLINE, Embase, CINAHL, PsycINFO, and Scopus databases. From these, the scientists collected a pool of 30 relevant publications. Most of the articles (24) focused on changes in indicators for the criteria that were subject to incentives, three studies - on the consequences of the withdrawal of criteria from the program, and three more - on both groups of criteria.

During the analysis of the first group of works, the researchers assessed changes in indicators for 83 criteria of medical care quality. During the year, higher than predicted actual growth was recorded: indicators for 74 of 83 criteria increased by an average of 6.1%. Three years after the introduction of incentives, the scientists recorded a significant decline in growth rates: indicators for 40 of 72 criteria increased by an average of only 0.7%.

In publications on the effects of the removal of incentives, scholars focused on the 31 criteria that were removed from funding. In this case, the actual decline in performance across all quality criteria was reported to be faster than expected over both the one-year and three-year periods. Performance declined by an average of 10.7% over the year and by 12.8% over the three years.

The researchers also looked at 19 criteria that were not rewarded at all. Over the course of a year, the scores for these criteria remained mostly the same, but over three years they dropped by an average of 1.9%.

The scientists came to the conclusion that the support measures were most effective in the first year after their introduction. By the third year, the indicators for simple criteria were not higher than expected, and the growth of indicators for complex criteria was even lower than predicted. The authors of the study also found "some evidence" that the improvement in the quality of medical care when incentives were introduced was potentially limited by the "ceiling effect", that is, situations when the indicator for the criterion was initially close to the maximum. The cancellation of incentives, in turn, led to a decrease in the quality of medical care. Often, indicators for criteria removed from the program returned to their original values. Sometimes the decline exceeded the growth recorded when the support measures were in effect.

The researchers were unable to find any convincing evidence of the impact of state support on non-incentivized criteria for providing medical care during the year. However, they noted that over the three-year period, some criteria showed a slight decrease in indicators compared to their values ​​before the introduction of QOF. In this regard, the researchers suggested that criteria for medical care not affected by incentive measures could potentially be displaced from the area of ​​interest of medical workers.

Russia also has a mechanism of state support for medical workers - some categories of primary health care specialists are provided with social benefits. In March 2024, the Russian Government significantly changed the terms of such measures. In addition to indexing payments for employees of clinics in sparsely populated areas, the adjustments provided for the official inclusion of FMBA of Russia doctors in the bonus rules, as well as the introduction of stricter control over the level of doctors' salaries.