The Tougher the Better: The Effect of an Increased Performance Threshold on the Performance of General Practitioners

Abstract

This paper investigates whether and how a change in the performance-related payment scheme motivated General Practitioners (GPs) in Scotland. It evaluates the effect of increases in April 2006 in the performance thresholds required for maximum payment under the Quality and Outcomes Framework (QOF). A difference-in-differences estimator with fixed effects was employed to examine the number of patients treated under clinical indicators whose payment schedules were revised, and these were compared with the figures for those indicators whose schedules remained unchanged. The results suggest that the increase in the maximum performance thresholds improved GPs’ performance by 1.77% on average. Low-performing GPs improved significantly more (13.22%) than their high-performing counterparts (0.24%). Changes in maximum performance thresholds are differentially effective in incentivising GPs and could be used further to raise GPs’ performance across all indicators.