Screening rates for two clinical indicators fell when financial incentives were removed, according to a study of US clinical indicators.

The research, led by Professor Helen Lester of the University of Manchester, suggested that policy makers and clinicians need to be aware that removing such incentives may lower performance levels over time.

Eight QOF indicators are due to be removed in the UK in 2011. But while existing research indicates that financial incentives lead to improvements in quality, few studies have examined the effect of their removal.

Researchers studied the affect of removing financial incentives from screening for diabetic retinopathy and for cervical cancer. They assessed the impact on patients at Kaiser Permanente North California, an integrated healthcare system in the US.

Screening rates for diabetic retinopathy rose from 84.9% to 88.1% over five years when financial incentives were attached to screening.

However, in the following four years after the incentives were removed this rate fell to 80.5%.

A similar picture was seen in screening for cervical cancer rates, which rose from 77.4% to 78% in two years with incentives. But this too fell once the financial incentives were removed after five years, to 74.3%.

Researchers acknowledged that the US system of indicator incentives differ from that in the UK. In the US, individual doctors' pay is not linked to indicator achievement.

Nevertheless, the results suggested that policy makers may need to consider a stepwise reduction of payments against indicators rather than a blanket removal, the authors said.

They added: ‘They may also need to introduce a system of monitoring achievement in areas where indicators have been removed... and perhaps decide a priori the level of decline in achievement that could trigger a review and possible reintroduction.'

LISTEN TO OUR PODCAST - Professor Helen Lester on the launch of pilot QOF indicators