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Financial incentives for GPs 'undermine motivation'

Financial incentive schemes for doctors can 'undermine motivation and worsen performance', academic experts have warned.

An analysis published on bmj.com by researchers from Australia found that current evidence on whether financial incentives were effective was ‘modest and inconsistent'.

An accompanying editorial by US academics said offering financial incentives to doctors ‘may reduce their desire to perform an activity for its inherent rewards'.

The Australian research team, led by Professor Paul Glasziou of Bond University in Australia,looked at the positive and negative effects of financial incentives across different health systems. 

They concluded said there were ‘many pitfalls' to financial incentives, and that although there was some evidence that schemes could sometimes improve the quality of care, they may also prove an expensive distraction.

The study concluded: ‘The evidence on whether financial incentives are more effective than other interventions is often weak and poorly reported.

‘As in the QOF, new incentive programmes should include research to examine the impact, downsides, and cost effectiveness of incentives, and this should include evaluation of the comparative effectiveness of different strategies in different contexts. Such research should also include long term follow-up, since behaviour may revert when incentives are withdrawn.'

‘While some commentators and policy makers believe financial incentives can reduce the delay between new evidence and changes to clinical practice, there are many pitfalls.'

An accompanying editorial by professors David Himmelstein and Steffie Woolhandler from City University of New York and Professor Dan Ariely from Duke University in North Carolina, said there was a ‘growing body of evidence from behavioural economics and social psychology indicates that rewards can undermine motivation and worsen performance on complex cognitive tasks.'

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