Overview

As employers and insurers in the United States begin to explore ways to promote health care quality through "value purchasing," there have been limited experiments with bonus payments or other direct financial incentives for better care. The United Kingdom has just implemented a much broader initiative to reward primary care providers for improved performance. For patients served through the National Health Service, care is managed by general practitioners; GPs are independent contractors whose payments are a mix of fee-for-service, salary, and capitation. Under a new standard contract negotiated by the NHS and physicians, 18 percent of total GP spending will be distributed on the basis of individual performance on measures of clinical quality, patient experience, and service improvements. Practices can earn up to 1,050 "quality points" for 146 different indicators, and will receive extra money for each point. The scoring system emphasizes care for coronary heart disease, hypertension, and diabetes, but providers can also score points for such factors as better record-keeping and shortened waiting times.

For more information, see Quality Incentives: The Case Of U.K. General Practitioners in the May/June 2004 issue of Health Affairs.