D6.3 – Report with empirical analysis of the impact of some of the incentives mapped in D6.2

Family doctors are busy, and health systems have long tried to nudge them towards better care using two very different tools: paying them bonuses for hitting quality targets, and simply showing them how they are doing compared with their peers. But which of these actually works, and does adding money on top of good feedback make any real difference? This report digs into that question using real primary care data from Catalonia (Spain) and the Province of Verona (Italy), two systems that have experimented with financial incentives and information feedback in different ways.

The report brings together four empirical studies. Three draw on the Catalan system, where the public health institute serves nearly 80% of the population and tracks over one hundred clinical quality indicators: one analyses a decade of data (2010 to 2019) to separate the effect of information from that of financial incentives, a second uses the staggered post-COVID return of incentives as a natural experiment to see how quality recovers after a shock, and a third is an ongoing trial that removes incentives and feedback to test what happens. The fourth study uses a matched patient and doctor dataset from Verona to assess whether paying GPs to keep better electronic records improves diabetes monitoring. Across all four, the methods range from interrupted time series and survival models to difference in differences and difference in discontinuities designs. The overall message is consistent and practical: transparent feedback to professionals is a powerful and low-cost lever on its own, financial incentives add targeted value for selected indicators and for accelerating recovery after disruptions, and the best schemes carefully choose which indicators to reward and keep monitoring performance over time.

What the deliverable contains:

• A long-term analysis (2010 to 2019) separating the effects of information feedback and financial incentives on quality of care in Catalan primary care
• A study of how quality indicators recovered after the COVID-19 shock, comparing practices where incentives were reintroduced early or late
• The design of an ongoing trial that removes incentives and information to isolate the specific contribution of each
• An Italian study on whether financially rewarding better electronic record-keeping improves diabetes monitoring, without increasing consultations or prescriptions
• Policy insights on how to design primary care incentive schemes, including indicator selection, targeting and continuous monitoring