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Quality in primary care · Jan 2010
An international perspective on the basis for payment for performance.
- Barbara Starfield and Derelie Mangin.
- Department of Health Policy and Management, Johns Hopkins University, 624 North Broadway, Room 452, Baltimore, MD 21205, USA. bstarfie@jhsph.edu
- Qual Prim Care. 2010 Jan 1; 18 (6): 399-404.
AbstractThis discussion paper reflects on the pay-for-performance system in UK general practice - the Quality and Outcomes Framework (QOF) - from an international viewpoint. The QOF intends to bring the best scientific evidence to bear on primary care practice. However, the QOF and patient-centred medicine are often at odds. Inadequacies and commercial bias in the creation of evidence make the scientific basis of the QOF questionable. The framework for the QOF does not align well with the scope of primary care, making its basis as a tool for quality measurement questionable. The extent of impact of the QOF on health outcomes and on equity of health outcomes needs examination. Attention to resolution of patients' problems is an important aim of quality improvement activities. Alternative modes of improving patient care may be better than the QOF.
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