Six of the seven studies showed positive but modest effects on quality of care for some primary outcome measures , but not all .
The use of financial incentives to reward PCPs for improving the quality of primary healthcare services is growing .
However , there is insufficient evidence to support or not support the use of financial incentives to improve the quality of primary health care .
BACKGROUND The use of blended payment schemes in primary care , including the use of financial incentives to directly reward ' performance ' and ' quality ' is increasing in a number of countries .
There are many examples in the US , and the Quality and Outcomes Framework ( QoF ) for general practitioners ( GPs ) in the UK is an example of a major system-wide reform .
Despite the popularity of these schemes , there is currently little rigorous evidence of their success in improving the quality of primary health care , or of whether such an approach is cost-effective relative to other ways to improve the quality of care .
OBJECTIVES The aim of this review is to examine the effect of changes in the method and level of payment on the quality of care provided by primary care physicians ( PCPs ) and to identify : i ) the different types of financial incentives that have improved quality ; ii ) the characteristics of patient population s for whom quality of care has been improved by financial incentives ; and iii ) the characteristics of PCPs who have responded to financial incentives .
Paying doctors by salary: a controlled study of general practitioner behaviour in England.
The study aim was to evaluate the impact of the experimental introduction of salaried contracts  in Engl and on  general practitioner ( GP ) behaviour  and the quality of care . A controlled before- and -after design was implemented involving ten practice s of st and ard contract GPs , paid largely by capitation and fee-for-service , and ten salaried GP practice s. Diaries and routinely available data were used to assess GP workload , and patient assessment s of the quality of care were obtained by postal question naire . GPs in salaried practice s spent less time on practice administration but more working out-of-hours and in direct patient care , allowing more patients to be seen . Total list sizes were smaller in salaried compared with st and ard contract practice s , but lists per GP were higher because of staffing policies . Salaried GPs tended to provide shorter consultations compared with st and ard contract GPs , prescribe in fewer consultations , but referral rates were similar . Quality was rated as higher for seven out of thirteen aspects of care examined in salaried practice s and two in st and ard contract practice s. However , none of these differences were statistically significant . To conclude , salaried contracts did not adversely affect GP productivity and had little impact on other aspects of GP behaviour or the quality of care provided
Six of the seven studies showed positive but modest effects on quality of care for some primary outcome measures , but not all .
The use of financial incentives to reward PCPs for improving the quality of primary healthcare services is growing .
However , there is insufficient evidence to support or not support the use of financial incentives to improve the quality of primary health care .
BACKGROUND The use of blended payment schemes in primary care , including the use of financial incentives to directly reward ' performance ' and ' quality ' is increasing in a number of countries .
There are many examples in the US , and the Quality and Outcomes Framework ( QoF ) for general practitioners ( GPs ) in the UK is an example of a major system-wide reform .
Despite the popularity of these schemes , there is currently little rigorous evidence of their success in improving the quality of primary health care , or of whether such an approach is cost-effective relative to other ways to improve the quality of care .
OBJECTIVES The aim of this review is to examine the effect of changes in the method and level of payment on the quality of care provided by primary care physicians ( PCPs ) and to identify : i ) the different types of financial incentives that have improved quality ; ii ) the characteristics of patient population s for whom quality of care has been improved by financial incentives ; and iii ) the characteristics of PCPs who have responded to financial incentives .