[Pay-for-performance in healthcare: effects are uncertain].

A British pay-for-performance scheme to improve medical care has attracted the attention of Dutch health authorities. An extensive pay-for-performance policy was introduced in general practices in the UK in 2004. In British patients with hypertension, however, financial incentives for healthcare providers did not appear to improve the quality of patient care. A temporary effect was seen among patients with asthma and diabetes. Unintended consequences were detected. The quality of care for patients in general practice was already improving before the change in policy. Based on these results, careful consideration is needed before the introduction of extensive pay-for-performance in Dutch general practice. Quality of care has been an issue for Dutch GP's for many years. General practitioners and health insurance companies should cooperate to identify those aspects of care needing further improvement. More can probably be gained from trust in GPs and the facilitating role of health insurance companies than from a pay-for-performance scheme.

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