Value for money and the Quality and Outcomes Framework in primary care in the UK NHS

Simon Walker; Anne R. Mason; Karl Claxton; Richard Cookson; Elisabeth Fenwick; Robert Fleetcroft; Mark Sculpher

doi:10.3399/bjgp10X501859

Value for money and the Quality and Outcomes Framework in primary care in the UK NHS

Simon Walker, Anne R. Mason, Karl Claxton, Richard Cookson, Elisabeth Fenwick, Robert Fleetcroft, Mark Sculpher

Research output: Contribution to journal › Article › peer-review

Abstract

Background

The Quality and Outcomes Framework (QOF) is a pioneering attempt to improve the quality of primary care in the UK through the use of financial rewards. Despite its achievements, there are concerns that the QOF rimy offer poor value for money.

Aim

To assess the Cost-effectiveness of QOF payments.

Design of study

Economic analysis.

Setting

England, UK.

Method

Cost-effectiveness evidence was identified for a subset of nine QOF indicators with a direct therapeutic impact. These data were then applied to an analytic framework to determine the conditions under which QOF payments would be cost-effective. This framework was constructed to assess the cost-effectiveness of QOF payments by modelling the incentive structure using cost-effectiveness thresholds of 20 000 and 30 000 per quality-adjusted life year (QALY) gained, to represent good value to the NHS. It used 2004/2005 data on the QOF performance of all English primary care practices.

Results

Average indicator payments ranged from 0.63 to 40.61 per patient, and the percentage of eligible patients treated ranged from 63% to 90%. The proportional changes required for QOF payments to be cost-effective varied widely between the indicators. Although most indicators required only a fraction of a 1% change to be cost-effective, for some indicators improvements in performance of around 20% were needed.

Conclusion

For most indicators that can be assessed, QOF incentive payments are likely to be a cost-effective use of resources for a high proportion of primary care. practices, even if the QOF achieves only modest improvements.in care. However, only a small subset of the indicators has been considered, and no account has been taken of the costs of administering the QOF scheme.

Original language	English
Pages (from-to)	e213-e220
Number of pages	8
Journal	British Journal of General Practice
Volume	60
Issue number	574
DOIs	https://doi.org/10.3399/bjgp10X501859
Publication status	Published - May 2010

Keywords

cost-effectiveness
family practice
health care
physician incentive plans
quality indicators
HEALTH-CARE
PERFORMANCE
PAY
HYPERTENSION
MANAGEMENT
ENGLAND
IMPROVE

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http://www.ingentaconnect.com/content/rcgp/bjgp/2010/00000060/00000574/art00003?token=005916ef4069205a666f3a7b6c7b4063765b6b635276662549264f655d375c6b687630502110e4d8897f2c4d6

Cite this

@article{683421a035fa468993660b08dbe4cdcb,

title = "Value for money and the Quality and Outcomes Framework in primary care in the UK NHS",

abstract = "BackgroundThe Quality and Outcomes Framework (QOF) is a pioneering attempt to improve the quality of primary care in the UK through the use of financial rewards. Despite its achievements, there are concerns that the QOF rimy offer poor value for money.AimTo assess the Cost-effectiveness of QOF payments.Design of studyEconomic analysis.SettingEngland, UK.MethodCost-effectiveness evidence was identified for a subset of nine QOF indicators with a direct therapeutic impact. These data were then applied to an analytic framework to determine the conditions under which QOF payments would be cost-effective. This framework was constructed to assess the cost-effectiveness of QOF payments by modelling the incentive structure using cost-effectiveness thresholds of 20 000 and 30 000 per quality-adjusted life year (QALY) gained, to represent good value to the NHS. It used 2004/2005 data on the QOF performance of all English primary care practices.ResultsAverage indicator payments ranged from 0.63 to 40.61 per patient, and the percentage of eligible patients treated ranged from 63% to 90%. The proportional changes required for QOF payments to be cost-effective varied widely between the indicators. Although most indicators required only a fraction of a 1% change to be cost-effective, for some indicators improvements in performance of around 20% were needed.ConclusionFor most indicators that can be assessed, QOF incentive payments are likely to be a cost-effective use of resources for a high proportion of primary care. practices, even if the QOF achieves only modest improvements.in care. However, only a small subset of the indicators has been considered, and no account has been taken of the costs of administering the QOF scheme.",

keywords = "cost-effectiveness, family practice, health care, physician incentive plans, quality indicators, HEALTH-CARE, PERFORMANCE, PAY, HYPERTENSION, MANAGEMENT, ENGLAND, IMPROVE",

author = "Simon Walker and Mason, {Anne R.} and Karl Claxton and Richard Cookson and Elisabeth Fenwick and Robert Fleetcroft and Mark Sculpher",

year = "2010",

month = may,

doi = "10.3399/bjgp10X501859",

language = "English",

volume = "60",

pages = "e213--e220",

journal = "British Journal of General Practice",

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T1 - Value for money and the Quality and Outcomes Framework in primary care in the UK NHS

AU - Walker, Simon

AU - Mason, Anne R.

AU - Claxton, Karl

AU - Cookson, Richard

AU - Fenwick, Elisabeth

AU - Fleetcroft, Robert

AU - Sculpher, Mark

PY - 2010/5

Y1 - 2010/5

N2 - BackgroundThe Quality and Outcomes Framework (QOF) is a pioneering attempt to improve the quality of primary care in the UK through the use of financial rewards. Despite its achievements, there are concerns that the QOF rimy offer poor value for money.AimTo assess the Cost-effectiveness of QOF payments.Design of studyEconomic analysis.SettingEngland, UK.MethodCost-effectiveness evidence was identified for a subset of nine QOF indicators with a direct therapeutic impact. These data were then applied to an analytic framework to determine the conditions under which QOF payments would be cost-effective. This framework was constructed to assess the cost-effectiveness of QOF payments by modelling the incentive structure using cost-effectiveness thresholds of 20 000 and 30 000 per quality-adjusted life year (QALY) gained, to represent good value to the NHS. It used 2004/2005 data on the QOF performance of all English primary care practices.ResultsAverage indicator payments ranged from 0.63 to 40.61 per patient, and the percentage of eligible patients treated ranged from 63% to 90%. The proportional changes required for QOF payments to be cost-effective varied widely between the indicators. Although most indicators required only a fraction of a 1% change to be cost-effective, for some indicators improvements in performance of around 20% were needed.ConclusionFor most indicators that can be assessed, QOF incentive payments are likely to be a cost-effective use of resources for a high proportion of primary care. practices, even if the QOF achieves only modest improvements.in care. However, only a small subset of the indicators has been considered, and no account has been taken of the costs of administering the QOF scheme.

AB - BackgroundThe Quality and Outcomes Framework (QOF) is a pioneering attempt to improve the quality of primary care in the UK through the use of financial rewards. Despite its achievements, there are concerns that the QOF rimy offer poor value for money.AimTo assess the Cost-effectiveness of QOF payments.Design of studyEconomic analysis.SettingEngland, UK.MethodCost-effectiveness evidence was identified for a subset of nine QOF indicators with a direct therapeutic impact. These data were then applied to an analytic framework to determine the conditions under which QOF payments would be cost-effective. This framework was constructed to assess the cost-effectiveness of QOF payments by modelling the incentive structure using cost-effectiveness thresholds of 20 000 and 30 000 per quality-adjusted life year (QALY) gained, to represent good value to the NHS. It used 2004/2005 data on the QOF performance of all English primary care practices.ResultsAverage indicator payments ranged from 0.63 to 40.61 per patient, and the percentage of eligible patients treated ranged from 63% to 90%. The proportional changes required for QOF payments to be cost-effective varied widely between the indicators. Although most indicators required only a fraction of a 1% change to be cost-effective, for some indicators improvements in performance of around 20% were needed.ConclusionFor most indicators that can be assessed, QOF incentive payments are likely to be a cost-effective use of resources for a high proportion of primary care. practices, even if the QOF achieves only modest improvements.in care. However, only a small subset of the indicators has been considered, and no account has been taken of the costs of administering the QOF scheme.

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KW - family practice

KW - health care

KW - physician incentive plans

KW - quality indicators

KW - HEALTH-CARE

KW - PERFORMANCE

KW - PAY

KW - HYPERTENSION

KW - MANAGEMENT

KW - ENGLAND

KW - IMPROVE

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SN - 0960-1643

VL - 60

SP - e213-e220

JO - British Journal of General Practice

JF - British Journal of General Practice

IS - 574

ER -

Value for money and the Quality and Outcomes Framework in primary care in the UK NHS

Abstract

Keywords

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