QOF widened health inequalities, study suggests

QOF initially widened health inequalities after its introduction in 2004, with people in deprived areas gaining less from the framework than those in other areas, a Manchester University study suggests.

QOF: incentives drove up care in affluent areas first
QOF: incentives drove up care in affluent areas first

Researchers showed that improvements resulting from the introduction of QOF were more pronounced in affluent areas, but that practices in poorer areas closed this gap in later years.

Dr Evangelos Kontopantelis and colleagues looked at General Practice Research Database records from 148 practices in England. They analysed data on 23,920 diabetes patients from 2000/01 to 2006/07, creating a composite score of the measures assessed under QOF diabetes indicators.

The researchers found that the introduction of financial incentives raised the recorded quality of diabetes care, but that improvements were not achieved equally by all practices.

‘Patients attending practices from the most deprived quartile appear to have gained less from the intervention compared with patients in the most affluent quartile of practices,’ they said.

Compared with performance estimated on the basis of pre-QOF data from all practices, the 25% of practices in the most deprived areas saw reductions in the quality of diabetes care. The researchers found a 4.9% fall in 2004/05 in the quality of diabetes care and a 3.8% fall in 2006/07, although practices in deprived areas subsequently improved their performance.

Dr Kontopantelis and his team said that, before the introduction of QOF, practices in deprived areas had provided slightly better diabetes care than those in more affluent areas.

‘However, recorded improvements in the first year of the QOF scheme were greater for practices in more affluent areas and practices in deprived areas therefore fell behind,’ they said. ‘In the second and third year of the scheme practices in deprived areas closed the gap again, as has been noted in previous research.'

The researchers added: ‘This suggests that practices in affluent areas were likely to have responded more quickly to the incentives, thus gaining a financial advantage in the early years of the scheme.’

The researchers also found that the main benefits resulting from the introduction of QOF related to improved recording of assessments, rather than patient management or care outcomes.

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