2. The Unintended Consequences of
Paying for Quality in Health Care
f l lh
Tim Doran
University of Manchester
Harvard School of Public Health
Nuffield Health Strategy Summit, 3 March 2011
Doran
NPCRDC Paying Physicians for Quality

3. • Adverse effect on professionalism and motivation
• Neglect of non‐incentivized activities
• Widening of health inequalities

4. Case Study One:
Quality and Outcomes Framework
Q lit dO t F k
Doran
NPCRDC Paying Physicians for Quality

5. Paying for quality The Quality and Outcomes Framework
The United Kingdom Results
The United States
Influenza immunisation
Influenza immunisation
Incentivized (CHD) and unincentivized (CKD)
100
95
90
85
ment rate
80
75
Achievem
Incentivized
70 Unincentivized
65
60
55
50
2000/1 2001/2 2002/3 2003/4 2004/5 2005/6 2006/7
NPCRDC Paying Physicians for Quality

6. Paying for quality The Quality and Outcomes Framework
The United Kingdom Results
The United States
Uplift in achievement
Uplift in achievement
Actual versus expected achievement: Year 1 (2004/5) and Year 3 (2006/7)
35  27  15
= 1 = 7
25  0  6
ent above
ed rate
15
 4  2
= 11 = 7
predicte
Achieveme
5  5  11
5
‐5
‐15
Year 1
Year 1 Year 3
Year 3
NPCRDC Paying Physicians for Quality

7. Adventures in Health Care Reform
Adventures in Health Care Reform
Doran
NPCRDC Paying Physicians for Quality

8. Potomac fever
Potomac fever
Doran
NPCRDC US Health Care Reform

9. Reform
eo
Past attempts
“Democrats want to create a
Democrats
government-run system for not
providing health care, while
care
Republicans say coverage is best
denied by allowing private insurers to
make it unaffordable for as many
citizens as possible ”
possible.
NPCRDC US Health Care Reform