A program that directly ties payment to quality of primary care may not have a considerable effect on patient mortality rates, and the relation between incentives and mortality “needs to be assessed in specific disease domains,” according to a study published May 17 in The Lancet.

The study, led by Andrew M. Ryan, PhD, et al., compared changes in population mortality between the United Kingdom’s (UK’s) Quality and Outcomes Framework, a pay-for-performance program, and countries not exposed to pay-for-performance programs using data from the World Health Organization mortality database between 1994 and 2010.

Results show that the introduction of the UK’s pay-for-performance program was not significantly associated with changes in population mortality for the composite outcome of its targeted disease areas: ischemic heart disease, hypertension, stroke, diabetes, chronic kidney disease, asthma and chronic obstructive pulmonary disease (-3.68 per 100,000 people [95 percent confidence interval -8.16 to 0.80]; p=0.107).

“Our research raises questions about whether pay-for-performance in other settings is a viable method to improve population health,” the authors state. They add that moving forward, the costs and effectiveness of pay-for-performance programs should be compared with other health system interventions to help determine how resources can be best used to improve population health.

In an accompanying editorial comment, Martin Roland, of the Institute of Public Health at the University of Cambridge in Cambridge, UK, explains that “societal changes remain very important to improvements in health, with population-wide secular changes in blood pressure and cholesterol still numerically more important in reducing coronary deaths in the UK than medications prescribed in primary care.” He stresses the importance of health care system that has a “strong preventive component” and includes physicians that advocate for measures to reduce behaviors that lead to illness and premature mortality. 

Keywords: Asthma, Blood Pressure, Blood Pressure Determination, Cholesterol, Confidence Intervals, Diabetes Mellitus, United Kingdom, Hypertension, Mortality, Premature, Motivation, Myocardial Ischemia, Primary Health Care, Public Health, Pulmonary Disease, Chronic Obstructive, Reimbursement, Incentive, Renal Insufficiency, Chronic, Stroke

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