Family doctor responses to changes in target stringency under financial incentives

Abstract: There is a risk that providers will engage in gaming if they self-report the targets on which they are monitored, regulated or rewarded. There is relatively little evidence on whether this occurs amongst health care providers. We examine how family doctors responded to a temporary but substantial increase in the stringency of the targets that governed their payments for ensuring patients diagnosed with hypertension had controlled blood pressure. We use patient-level data from 129 family practices over a seven-year period (2010 to 2016) to examine whether family doctors changed their diagnostic behaviour, increased treatment intensity, exempted patients, increased rates of testing and/or gamed the recording of the blood pressure measurements. There was some evidence of more intense treatment but also clear evidence of increased exemption of patients and bunching of recorded measurements just under the target level. These results suggest that doctors will game in response to changing performance targets under financial incentives.