The Tougher the Better: An Economic Analysis of Increased Payment Thresholds on the Performance of General Practices
Article first published online: 5 JAN 2014
Copyright © 2013 John Wiley & Sons, Ltd.
Volume 24, Issue 3, pages 353–371, March 2015
How to Cite
2015), The Tougher the Better: An Economic Analysis of Increased Payment Thresholds on the Performance of General Practices, Health Econ., 24, 353–371, doi: 10.1002/hec.3022, , , and (
- Issue published online: 23 JAN 2015
- Article first published online: 5 JAN 2014
- Manuscript Accepted: 12 NOV 2013
- Manuscript Revised: 14 AUG 2013
- Manuscript Received: 30 MAR 2012
- financial incentives;
- quality and outcomes framework;
- general practitioners
We investigate whether and how a change in performance-related payment motivated General Practitioners (GPs) in Scotland. We evaluate the effect of increases in the performance thresholds required for maximum payment under the Quality and Outcomes Framework in April 2006. 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 to compare these with the figures for those indicators whose schedules remained unchanged. The results suggest that the increase in the maximum performance thresholds increased GPs' performance by 1.77% on average. Low-performing GPs improved significantly more (13.22%) than their high-performing counterparts (0.24%). Changes to maximum performance thresholds are differentially effective in incentivising GPs and could be used further to raise GPs' performance across all indicators. Copyright © 2013 John Wiley & Sons, Ltd.