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EQUITY IN PRIMARY CARE PAYING FOR PERFORMANCE. TIM DORAN UNIVERSITY OF YORK. HEALTH INEQUALITY IMPACT OF PRIMARY CARE PAYING FOR PERFORMANCE. HEALTH INEQUALITIES IN ENGLAND. PRIMARY CARE AND HEALTH DISPARITY. SOURCE: DORLING ET AL, GRIM REAPER’S ROAD MAP, BRISTOL 2008.
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EQUITY IN PRIMARY CARE PAYING FOR PERFORMANCE • TIM DORAN • UNIVERSITY OF YORK
HEALTH INEQUALITYIMPACT OF PRIMARY CARE PAYING FOR PERFORMANCE
HEALTH INEQUALITIES IN ENGLAND PRIMARY CARE AND HEALTH DISPARITY SOURCE:DORLING ET AL, GRIM REAPER’S ROAD MAP, BRISTOL 2008
HEALTH INEQUALITYIMPACT OF PRIMARY CARE PAYING FOR PERFORMANCE
1948: THE NATIONAL HEALTH SERVICE PRIMARY CARE AND HEALTH DISPARITY BEVERIDGE AND THE FIVE GIANTS
“…at best… very unsatisfactory and at worst a positive source of public danger.” PRIMARY CARE UNDER THE NHS “Conditions are… bad enough to turn a good doctor into a bad one within a very short time.” PRIMARY CARE AND HEALTH DISPARITY SOURCE: COLLINGS, LANCET 1950; 6625: 555-585.
GLYNCORRWG POPULATION 1900 64% UNSKILLED HEALTH CENTRE ‘SCREENING’ FOR BP, SMOKING, CHOLESTEROL, DIABETES, LUNG FUNCTION, BMI, ALCOHOLISM MORTALITY SMR 94 (-6%) (BLAENGWYNFI 16O) REPEALING THE INVERSE CARE LAW PRIMARY CARE AND HEALTH DISPARITY SOURCE: TUDOR HART ET AL, BMJ 1991; 302: 1509-1503.
HEALTH INEQUALITYIMPACT OF PRIMARY CARE PAYING FOR PERFORMANCE
INTRODUCED 2004 (ALL UK GENERAL PRACTICES) • 146 QUALITY INDICATORS COVERING: • MANAGEMENT OF CHRONIC CONDITIONS • ORGANISATION OF CARE • PATIENT EXPERIENCE • INDICATORS WORTH 0.5-57 POINTS (TOTAL 1,000) • 1 POINT = £125 (€145) • PRACTICES EXCLUDE INAPPROPRIATE PATIENTS • ACHIEVEMENT SCORES PUBLICLY REPORTED QUALITY & OUTCOMES FRAMEWORK PRIMARY CARE AND HEALTH DISPARITY OVERVIEW OF THE QUALITY & OUTCOMES FRAMEWORK
POINTS: 0-19 PAYMENT: £0-1,444 E.G.: CONTROL OF BLOOD PRESSURE LOWERTHRESHOLD UPPER THRESHOLD PERCENTAGE ACHIEVEMENT PRIMARY CARE AND HEALTH DISPARITY CHD6: PERCENTAGE OF CHD PATIENTS WITH BP ≤150/90 MMHG
REPORTED ACHIEVEMENT IMPACT ON INEQUALITIES 2004/5 2005/6 2006/7 PRIMARY CARE AND HEALTH DISPARITY SOURCE:DORAN ET AL. LANCET 2008; 372: 728-736.
PROCESSES OUTCOMES IMPACT ON INEQUALITIES ACHIEVEMENT DEPRIVATION QUINTILE PRIMARY CARE AND HEALTH DISPARITY DIABETES INDICATORS, BY DEPRIVATION QUINTILE
ACHIEVEMENT ABOVE PREDICTED NON-INCENTIVIZED ACTIVITIES NO EFFECT 2004/5 2006/7 PRIMARY CARE AND HEALTH DISPARITY SOURCE:DORAN ET AL. BMJ 2011; 342: D3590.
RELATIVE GAIN SYSTEM ADVANTAGES COMPUTING SYSTEM PRIMARY CARE AND HEALTH DISPARITY ADDITIONAL REMUNERATION COMPARED WITH SYSTEM ‘G’
VIEWS OF PRACTITIONERS PRIMARY CARE AND HEALTH DISPARITY SOURCE: WEHRLI U, FUR ELISE
“It's a good idea – I think it makes things tangible and quantifies things…” “…although I hate it. I do.” PRIMARY CARE AND HEALTH DISPARITY SOURCE: MCDONALD ET AL. BMJ 2007; 334: 1357-1362.
QUESTIONS?PAYING FOR PERFORMANCE TIM.DORAN@YORK.AC.UK
PATIENTS PER PHYSICIAN EQUITABLE CARE PROVISION? DEPRIVATION ‘DECILE’ PRIMARY CARE AND HEALTH DISPARITY DISTRIBUTION OF PRIMARY CARE PHYSICIANS (1996)