How acceptable are financial incentives and written feedback for improving hypertension control? Perspectives from physicians, clinic administrators, and patients

Objectives: To assess attitudes of physicians, clinic administrators, and patients within a health maintenance organization (HMO) toward using financial incentives to improve the control of hypertension. Study Design: Descriptive study of attitudes toward use of financial incentives paid to physicians or to clinic systems. Methods: Data were collected through physician survey (n = 104), interviews with clinic administrators (n = 24), and patient focus groups (n = 3) during the winter of 1999 and the spring of 2000. Analyses included both qualitative and quantitative approaches. Results: Most physicians (80%) supported additional funding to clinics to create systems to improve hypertension care. However, less than half supported direct payment to either groups of physicians (38%) or individual physicians (24%). Sixty-four percent of clinic administrators supported incentive payments to clinics to improve quality of care, whereas only 42% favored incentives to physicians. Patients had a uniformly favorable view of incentives paid to clinics, but were strongly opposed to direct physician incentives. Written feedback was supported by both clinic administrators (54%) and physicians (74%). Conclusions: In this nonprofit HMO, none of the stakeholder groups supported direct incentive payments to physicians to improve hypertension control. Trials of financial incentives within managed care organizations should include study arms with clinic-based incentives. Further study is needed to determine if incentives to clinics, which appear to be acceptable, can actually improve blood pressure control.