Financial incentives may be effective in changing healthcare professional practice .
We found no evidence from review s that examined the effect of financial incentives on patient outcomes
BACKGROUND There is considerable interest in the effectiveness of financial incentives in the delivery of health care .
Incentives may be used in an attempt to increase the use of evidence -based treatments among healthcare professionals or to stimulate health professionals to change their clinical behaviour with respect to preventive , diagnostic and treatment decisions , or both .
Financial incentives are an extrinsic source of motivation and exist when an individual can expect a monetary transfer which is made conditional on acting in a particular way .
Since there are numerous review s performed within the healthcare area describing the effects of various types of financial incentives , it is important to summarise the effectiveness of these in an overview to discern which are most effective in changing health professionals ' behaviour and patient outcomes .
OBJECTIVES To conduct an overview of systematic review s that evaluates the impact of financial incentives on healthcare professional behaviour and patient outcomes .
The extent of the two tier service for fundholders
Abstract Objective : To examine possible differential changes in outpatient referrals to orthopaedic clinics , attendances , and waiting times between  fundholding and non-fundholding general practitioners . Design : Observational controlled study of referrals by general practitioners to orthopaedic out patients between April 1991 and March 1995 . Setting : District health authority in south west Engl and . Subjects : 10 fundholding practice s with 108 300 registered patients ; 22 control practice s with 159 900 registered patients . Main outcome measures : Changes in age st and ardised referral and outpatient attendance ratios for the year before and the two years after achieving fundholder status ; changes in outpatient waiting times . Results : In the year before achieving fundholding status both groups were referring more patients than were being seen . Two years later , referral and attendance ratios had increased by 13 % and 36 % respectively for fundholders and 32 % and 59 % for controls , and both groups were referring fewer patients than were being seen . Attendances represented 112 % of referrals for fundholders and 104 % for controls . In 1991 - 2 , a similar proportion of patients in the two groups was seen within three months of referral . The two hospitals that set up specific clinics exclusively for fundholders showed faster access for patients of fundholders by 1993 - 4 , as did a third hospital without such clinics by 1994 - 5 . Conclusions : Fundholders increased their orthopaedic referrals less than did controls and achieved a better balance between outpatient appointments and referrals . Their patients were likely to be seen more quickly , particularly if the hospital provided special clinics exclusively for fundholders . Lack of case mix information makes it impossible to judge whether these differences benefit or disadvantage patients . Key messages Patients of fundholders had no better access than patients of non-fundholders to orthopaedic services before the practice s became fundholding Fundholders controlled their referrals better than non-fundholders and achieved a better balance between referrals and attendances Fundholders ' patients were more likely to be seen quickly , especially if the receiving hospital laid on specific clinics exclusively for fundholders Information on case mix is needed to identify whether the lower referral rate among fundholders benefits or disadvantages
Financial incentives may be effective in changing healthcare professional practice .
We found no evidence from review s that examined the effect of financial incentives on patient outcomes
BACKGROUND There is considerable interest in the effectiveness of financial incentives in the delivery of health care .
Incentives may be used in an attempt to increase the use of evidence -based treatments among healthcare professionals or to stimulate health professionals to change their clinical behaviour with respect to preventive , diagnostic and treatment decisions , or both .
Financial incentives are an extrinsic source of motivation and exist when an individual can expect a monetary transfer which is made conditional on acting in a particular way .
Since there are numerous review s performed within the healthcare area describing the effects of various types of financial incentives , it is important to summarise the effectiveness of these in an overview to discern which are most effective in changing health professionals ' behaviour and patient outcomes .
OBJECTIVES To conduct an overview of systematic review s that evaluates the impact of financial incentives on healthcare professional behaviour and patient outcomes .