Primary care health screening in patients with severe mental illness: What influence do financial incentives have?

The Quality-of-Care Framework (QOF) aims to improve patient care for at risk groups through financial incentivisation. This study assesses the effect of changes in incentivisation of four health indicators for people with severe mental illness (SMI) on their recording versus controls. 9,250 patients with SMI aged >18 from South London and 12,729 controls were included using linked primary and mental healthcare records between 2006-2020. Mixed effect logistic regression controlling for age, gender, and neighbourhood deprivation estimated effects of incentivisation on health indicators in SMI and controls, and compared periods with/without incentivisation within the SMI sample and between SMI diagnostic groups. SMI patients overall were more likely than controls to be checked for all health indicators, and incentivisation was associated with increases in all screening measures in SMI compared to controls. In SMI patients, compared to pre-incentivisation, the likelihood of being checked increased overall (ranging from OR = 1.48 p < .001 for blood pressure to OR = 3.70 p < .001 for alcohol consumption); for alcohol consumption, however, this likelihood dropped significantly to lower odds when de-incentivised compared to the pre-incentivisation period (OR = 0.83 p < .001). Impacts were similar across SMI categories. While primary care financial incentivisation is associated with improved health screening in adults with SMI, its duration can impact quality of care, raising concerns over health inequalities in people with SMI and on the effectiveness of incentivised performance in healthcare.