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England's Pay-for-Performance Scheme Faulted

Quality of care measures for asthma, diabetes and heart disease slowed after implementation

WEDNESDAY, July 22 (HealthDay News) -- The 2004 pay-for-performance scheme for family practices in England resulted in short-term quality of care improvements for asthma and diabetes, but not for heart disease, and ultimately was associated with a long-term slowing in the rate of improvement for all three conditions, according to an article published in the July 23 issue of the New England Journal of Medicine.

Stephen M. Campbell, Ph.D., of the University of Manchester in the United Kingdom, and colleagues analyzed quality of care measures at 42 family practices at two time periods (1998 and 2003) before the scheme implementation and during two time periods (2005 and 2007) after implementation.

The researchers found that rates of quality improvement for asthma, diabetes, and heart disease -- regardless of whether or not the aspects of care were associated with incentives -- significantly slowed after 2005.

"If the aim of pay for performance is to give providers incentives to attain targets, the scheme achieved that aim," the authors conclude. "There may have been unintended consequences, including reductions in the quality of some aspects of care not linked to incentives and in the continuity of care."

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