![]() Pay-for-performance schemes have been implemented in many healthcare systems in both high income and low-middle income countries. ![]() No significant differences were observed between Scotland and England for influenza immunisation and antiplatelet or anticoagulant treatment for coronary heart disease three years after withdrawal of incentives. Substantial reductions were, however, also observed for intermediate outcomes, including blood pressure control in patients with peripheral arterial disease (−18.5, −22.1 to −14.9), stroke or transient ischaemic attack (−16.6, −20.6 to −12.7), hypertension (−13.7, −19.4 to −7.9), diabetes (−12.7, −15.0 to −12.4), or coronary heart disease (−12.8, −14.9 to −10.8), and for glycated haemoglobin control in people with HbA 1c levels ≤75 mmol/mol (−5.0, −8.4 to −1.5). ![]() At three years, the absolute percentage point difference between Scotland and England was largest for recording (by tick box) of mental health care planning (−40.2 percentage points, 95% confidence interval −45.5 to −35.0) and diabetic foot screening (−22.8, −33.9 to −11.7). Results A significant decrease in performance was observed for 12 of the 16 quality of care indicators in Scotland one year after QOF was abolished and for 10 of the 16 indicators three years after QOF was abolished, compared with England. 6Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK.5Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK.4Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.3Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK.2National Institute for Health and Care Excellence, Centre for Guidelines, Manchester, UK.1Division of Population Health and Genomics, University of Dundee, UK.Bruce Guthrie, professor of general practice 6.Matt Sutton, professor of health economics 5,.Martin Roland, emeritus professor of health services research 4,. ![]()
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