title: Effect of payment incentives on cancer screening in Ontario primary care.
abstract: OBJECTIVE
  There is limited evidence for the effectiveness of pay for performance despite its widespread use. We assessed whether the introduction of a pay-for-performance scheme for primary care physicians in Ontario, Canada, was associated with increased cancer screening rates and determined the amounts paid to physicians as part of the program.
  
  
  METHODS
  We performed a longitudinal analysis using administrative data to determine cancer screening rates and incentive costs in each fiscal year from 1999/2000 to 2009/2010. We used a segmented linear regression analysis to assess whether there was a step change or change in screening rate trends after incentives were introduced in 2006/2007. We included all Ontarians eligible for cervical, breast, and colorectal cancer screening.
  
  
  RESULTS
  We found no significant step change in the screening rate for any of the 3 cancers the year after incentives were introduced. Colon cancer screening was increasing at a rate of 3.0% (95% CI, 2.3% to 3.7%) per year before the incentives were introduced and 4.7% (95% CI, 3.7% to 5.7%) per year after. The cervical and breast cancer screening rates did not change significantly from year to year before or after the incentives were introduced. Between 2006/2007 and 2009/2010, $28.3 million, $31.3 million, and $50.0 million were spent on financial incentives for cervical, breast, and colorectal cancer screening, respectively.
  
  
  CONCLUSIONS
  The pay-for-performance scheme was associated with little or no improvement in screening rates despite substantial expenditure. Policy makers should consider other strategies for improving rates of cancer screening.
authors.affiliation: Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada Department of Family and Community Medicine, University of Toronto, Ontario, Canada tara.kiran@utoronto.ca.
authors.forename: Tara
authors.initials: T
authors.lastname: Kiran
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Wilton
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Dalla Lana School of Public Health, Toronto, Ontario, Canada.
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Paszat
authors.affiliation: Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada Department of Family and Community Medicine, University of Toronto, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Dalla Lana School of Public Health, Toronto, Ontario, Canada.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Glazier
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000517:prevention & control; D015179:Colorectal Neoplasms / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010816:Physician Incentive Plans / Q000191:economics*; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000191:economics*; D012052:Reimbursement, Incentive; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control
keywords: cancer screening; delivery of health care; pay for performance; primary health care; quality of health care