Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments

Does Pay For Performance Improve Healthcare Quality?

The Jobbing Doctor, a primary care doctor in the UK, writes about the British version of what Americans call “Pay for Performance,” or “P4P.”

He says something I’ve said many times before (like here, here, and here).  Which is this: incentives fail because they try to treat medicine as an assembly line process, when it’s not.

But what’s most interesting about his post is that it could have been written by a doctor from anyplace on the planet Earth.

The Jobbing Doctor talks about a UK program that started in 2004 called the Quality and Outcomes Framework, or “QoF.”   Now, the American “P4P” is a much more catchy name, so score one for American marketing.  But it doesn’t matter what you call it – that which we call a rose would, by any other name smell as sweet.

Or, as in this case, as sour.

According to the Jobbing Doctor, QoF has actually increased costs (or at least doctors’ income- he says it went up 33%) because the government seemed to have underestimated the extent to which doctors were already delivering high quality primary care.  He also notes that because the guidelines are so crude and so focused on certain illnesses, there are incentives to meet targets rather than understanding a patient’s medical condition.  It’s pretty much the opposite of what doctors are taught to do in their training.  And his complaints about QoF sound very similar to complaints from doctors in other countries about the impact of such well-meaning efforts by government and private industry.

Which is the larger point.

As Jobbing Doctor put it so eloquently, measures like these distort the practice of medicine and take it away from what is really important:

The other downside is that ideas like the QoF diminish a profession’s values and judgements, meaning that high quality care is not driven by an internal motivation for doing a good and valuable job well, rather we have to be driven by targets.  Targets are the antithesis of professionalism.

So, yes, the quality of medical care needs to improve.  But how you define quality is the first question that must be answered.  If I’m sick, I want my doctor motivated – and paid – to do “a good and valuable job well.”

*This blog post was originally published at See First Blog*

You may also like these posts

    None Found

Read comments »

Comments are closed.

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »