Austerity may sharpen neglect of non-incentivised activity
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Rapid response to:
Research
Effect of financial incentives on incentivised and non-incentivised clinical activities: longitudinal analysis of data from the UK Quality and Outcomes Framework
Austerity may sharpen neglect of non-incentivised activity
Tim Doran and colleagues are to be congratulated on a first class
piece of health services research into the effects of the QOF, the UK's
pioneering "pay for performance" scheme in primary care.
An important
worry about schemes of this kind is that: "what doesn't get incentivised
gets marginalised". However, Doran and colleagues find that the non-incentivised aspects of primary care quality that they were able to
measure were only slightly neglected. Does that mean policy makers can
relax and stop worrying about the unintended consequences of "pay for
performance" schemes? Unfortunately not. This particular "pay for
performance" scheme was implemented in a resource-rich climate of
accelerating health expenditure growth. In this favourable financial
climate, primary care providers had the capacity to hire new staff and do
more QOF activity without having to do less non-QOF activity. The iron
law of opportunity cost still held true in the "golden age" of NHS
spending growth in the 2000s - its just that the opportunities forgone
were the unmeasured and largely unnoticed opportunities to new things
other than QOF activity. No-one needs reminding that the financial
climate has changed. Resources are tight; budget constraints are hard;
opportunities foregone are not just bright ideas for doing new things with
extra resources. In these more austere times, what gets marginalised may
get noticed.
Rapid Response:
Austerity may sharpen neglect of non-incentivised activity
Tim Doran and colleagues are to be congratulated on a first class
piece of health services research into the effects of the QOF, the UK's
pioneering "pay for performance" scheme in primary care.
An important
worry about schemes of this kind is that: "what doesn't get incentivised
gets marginalised". However, Doran and colleagues find that the non-incentivised aspects of primary care quality that they were able to
measure were only slightly neglected. Does that mean policy makers can
relax and stop worrying about the unintended consequences of "pay for
performance" schemes? Unfortunately not. This particular "pay for
performance" scheme was implemented in a resource-rich climate of
accelerating health expenditure growth. In this favourable financial
climate, primary care providers had the capacity to hire new staff and do
more QOF activity without having to do less non-QOF activity. The iron
law of opportunity cost still held true in the "golden age" of NHS
spending growth in the 2000s - its just that the opportunities forgone
were the unmeasured and largely unnoticed opportunities to new things
other than QOF activity. No-one needs reminding that the financial
climate has changed. Resources are tight; budget constraints are hard;
opportunities foregone are not just bright ideas for doing new things with
extra resources. In these more austere times, what gets marginalised may
get noticed.
Competing interests: No competing interests