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Do the incentive payments in the new NHS contract for primary care reflect likely population health gains?

Fleetcroft, R. and Cookson, R. (2005) Do the incentive payments in the new NHS contract for primary care reflect likely population health gains? Research Report. CHE Research Paper (3). Centre for Health Economics , York, UK.

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The new contract for primary care in the UK offers fee-for-service payments for a wide range of activities in a quality outcomes framework, with payments designed to reflect likely workload. This study aims to explore the link between these financial incentives and the likely population health gains.


The study examines a subset of eight preventive interventions covering 38 of the 81 clinical indicators in the quality framework. The maximum payment for each service was calculated and compared with the likely population health gain in terms of lives saved per 100,000 population based on evidence from McColl et al. (1998).


Maximum payments for the eight interventions examined make up 57% of the sum total maximum payment for all clinical interventions in the quality outcomes framework. There appears to be no relationship between pay and health gain across these eight interventions. Two of the eight interventions (warfarin in atrial fibrillation and statins in primary prevention) receive no incentive.


Payments in the new contract do not reflect likely population health gain. There is a danger that clinical activity may be skewed towards high-workload activities that are only marginally effective, to the detriment of more cost effective activities. If improving population health is the primary goal of the NHS, then fee-for-service incentives should be designed to reflect likely health gain rather than likely workload.

Item Type: Monograph (Research Report)
Copyright, Publisher and Additional Information: © 2005 R. Fleetcroft, R. Cookson. The full text of this report can be viewed free of charge from the Centre for Health Economics web site at: http://www.york.ac.uk/inst/che/pdf/rp3.pdf Subsequently published - see http://eprints.whiterose.ac.uk/6715/
Keywords: health policy, incentive payments, primary care, quality, UK
Institution: The University of York
Academic Units: The University of York > Centre for Health Economics (York)
Depositing User: Repository Officer
Date Deposited: 24 Apr 2006
Last Modified: 21 Dec 2010 17:11
Published Version: http://www.york.ac.uk/inst/che/pdf/rp3.pdf
Status: Published
Publisher: Centre for Health Economics
Refereed: No
Related URLs:
URI: http://eprints.whiterose.ac.uk/id/eprint/1176

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