Effect of Payment Incentives on Cancer Screening in Ontario Primary Care

As the Provincial Primary Care Lead at Cancer Care Ontario and a family doctor working in the trenches in the Jane Finch corridor in Toronto, I would like to respond to the article, "Effect of Payment Incentives on Cancer Screening in Ontario Primary Care."

While the findings of this article have concluded that pay for performance incentives were associated with minimal increases in cancer screening rates, our practice has found the preventative care bonuses beneficial and an incentive to improve patient care. As a result of these incentives, our practice has developed a quality improvement plan for cancer screening and used part of the funding provided by the incentives to hire an additional staff person dedicated to telephoning and booking patients due for screening.

The article states that screening rates increased from 55% to 57% for cervical cancer screening, 60% to 63% for breast cancer screening, and 20% to 51% for colorectal cancer screening, and suggest that these changes are not significant. While at first glance these numbers may seem small, it is important to provide context for these statistics within Ontario's large population. An increase in 3%, for example, as noted within the study timeframe for cervical screening rates, translates into tens of thousands of additional women being screened for cervical cancer. This increase is a significant achievement in such a short amount of time.

It is also important to note that pay-for-performance incentives are one initiative of many to increase screening rates. It is limiting to suggest that pay-for-performance incentives alone can bend the curve; rather, multiple approaches to improve screening rates are likely the most effective approach.

While there are always opportunities to improve, and implementing pay-for-performance incentives are no exception, Ontario primary care physicians have been able to increase screening over the years which has resulted in better care for the patients of this province. This is likely a result of a variety of different approaches which for some physicians includes financial incentives. Before a careful review of these primary care incentives is undertaken, we should be careful not to throw the baby out with the bathwater.

Competing interests: None declared

Financial incentives can affect behaviour and are expected to have their place in physician remuneration models in the future. However, as this study demonstrates, these schemas are not likely useful in achieving better coverage for cancer screening and probably other care activities, at least not without compromising the doing of another task. This is because there isn't enough time to do all the required primary and secondary preventive care, and money doesn't create time unless it is used to hire help or buy tools that support better care. In that case, why not invest in such structures directly. I believe that family physicians don't need financial incentives to motivate their patient care. Rather practices need support in optimizing effectiveness and efficiency. Evidence suggests that a number of organizational structures can achieve this, including electronic tools, adequate team structure, and established processes

Simone

Competing interests: None declared