Paying doctors financial rewards to meet targets for improving the care of patients made no discernible difference to the health or treatment of people with high blood pressure, a study has found.
The findings suggest governments and health insurers across the world may be wasting billions of dollars on doctor incentive schemes but getting no improvement in patient care, researchers who conducted the study said.
Researchers from Britain, the United States and Canada assessed the impact of incentivized targets on quality of care and health outcomes in around 470,000 British patients with hypertension and found that they had no impact on rates of heart attacks, kidney failure, stroke or death.
"No matter how we looked at the numbers, the evidence was unmistakable; by no measure did pay-for-performance benefit patients with hypertension," said Brian Serumaga of Britain's Nottingham University, who led the research.
Fellow researcher Stephen Soumerai, of the department of population medicine at Harvard Medical School in the United States, said governments and private insurers "are likely wasting many billions on policies that assume that all you have to do is pay doctors to improve quality of medical care."
"Based on our study ... that assumption is questionable at best," he said in a statement about the findings, which were published in the British Medical Journal on Wednesday.
With healthcare costs and demand rising across the world, governments are looking at incentive schemes as possible ways of encouraging people to lead more healthy lives, and encouraging doctors to be more pro-active in their care so that patients' health does not worsen and become more expensive to treat.
Experts estimate that up to 1 billion people globally have high blood pressure, which is a major risk factor for heart disease, the leading cause of death worldwide. If left untreated, it can cause strokes, heart attacks and organ damage.
A report on Monday said that in the United States, the costs of heart disease will triple by 2030 to more than $800 billion a year, and treating high blood pressure will be the most expensive part, reaching $389 billion by 2030.
For this study, researchers looked at data from the UK Quality and Outcomes Framework — a voluntary system of financial incentives for family doctors, in place since 2004.
The program includes specific targets for doctors to show high quality care of patients with high blood pressure.
Britain's taxpayer-funded National Health Service committed 1.8 billion pounds ($2.9 billion) to the hypertension incentives project, and yet, the researchers said, to date there is little evidence that incentivised targets are effective.
The researchers looked at various measures including blood pressures over time, rates of blood pressure monitoring, and hypertension outcomes as well as illnesses.
Even after allowing for variations, their analysis showed no identifiable impact on incidence of strokes, heart attacks, renal failure, heart failure or death either in patients who started treatment before 2001 or in those who started treatment around the time when pay-for-performance targets were launched.