Send to friendAuthor Cheryl Cashin describes the Quality and Outcomes Framework (QOF) – the UK’s public health care approach that includes voluntary performance-based incentives. QOF is a national program with almost all General Practitioner (GP) practices participating. In 2009 it covered nearly 100% of registered patients.
The study situates the QOF within a broader context of the overall health system reform that has occurred in the last ten years, that resulted in increased spending on public health, improved accountability and well-defined standards for service providers.
As noted by the authors of the National Health Service Plan for Reform and Investment, even though incentive schemes had been used in the UK prior to the reform, their focus was too narrow and came down to “squeezing more treatment from the same resources”. The new approach was designed to promote quality, patient responsiveness and cooperation with local authorities.
In 2009, QOF consisted of 134 indicators distributed across 4 domains: clinical care, organizational, patient experience and additional services. Indicators in clinical care were designed to measure the quality of care and extent of control of mostly chronic non-communicable diseases such as coronary heart disease, heart failure, and hypertension. Indicators could have different point values – those in the “patient experience” domain were assigned high values of 30+ points and the organizational ones had low values of below 10. The target for practitioners was to accumulate quality points up to a maximum of 1000. Performance incentives are disbursed annually upon verifying the achievement of the targets. There was a “total bonus” available for earning the maximum of 1000 points.
So far there has been no rigorous evaluation of the QOF program. The preliminary studies have shown that although the GP practices have consistently achieved high scores on performance targets (especially long-term conditions such as asthma and diabetes), the program itself has had a modest impact on quality and patient outcomes. Efforts have been made to leverage the program and improve its outcomes. These efforts include: internal changes made by the GP practices to tailor their services to the program’s targets, a portion of additional funding allocated by the practices to employ new staff, greater role of the IT, and external support from Primary Care Trusts (PCT) teams.