A study released today by the Cochrane Library suggests that Australia should ‘proceed with caution’ when setting up financial incentives for quality care by GPs.
Study co-author Dr Peter Sivey from the Melbourne Institute of Applied Economic and Social Research (Uni of Melbourne) said that although there are hundreds of schemes across the world where the payment of doctors is deliberately organised to change the way GPs work, results on the effectiveness of this method were far from conclusive.
“In most cases, the problem with assessing the results of these schemes is a lack of quality data. This is partly due to the complexities of evaluating a policy or systems intervention, compared with a clinical trial of a specific treatment,” Dr Sivey said.
Dr Sivey said the study had identified the possibility that incentive schemes may not produce any effect and could even have unintended consequences. “In some situations where financial incentives are in place, they may work well for one disease area, but at the cost of doctors spending less time with other disease areas,” Dr Sivey explained.
Dr Sivey also discussed the implications of the study for policymakers in Australia. “The National Health and Hospitals Reform Commission recommended setting up financial incentives for General Practitioners to reward high quality of care, so this is something already on the table in Australia,” Dr Sivey said.
“The Federal Government is funding a $30.2 million pilot of financial incentives for diabetes care. This pilot should provide an opportunity to further analyse the benefits and drawbacks of financial incentives for GPs in the Australian context.” It is important that the data from this intervention be made publicly available so that all stakeholders can learn from the results.”
As an economist Dr Sivey said that he believed that incentive programs were likely to change clinicians’ behaviour. However, he said that the way in which they do so is dependent upon the environment in which the incentive program is implemented and that they may also have unintended negative consequences, such as spending less time than is optimum on non-incentivised activities.
Some other potential pitfalls with incentive programs that Australia might wish to avoid include under-estimating the response of doctors to incentives (and therefore over-spending the program) as occurred in the UK; and failing to recognise the potential of doctors to ‘game’ the system (inappropriately change their practice to maximise incentives).
“Incentive programs are likely to have an important place in the future of health care in Australia. However, they should not be seen as a solution to all the problems with the health care system.” Dr Sivey concluded.