Logo of amjphAmerican Journal of Public Health Web SiteAmerican Public Health Association Web SiteSubmissionsSubscriptionsAbout Us
Am J Public Health. 1998 November; 88(11): 1699–1701.
PMCID: PMC1508575

Physician financial incentives and feedback: failure to increase cancer screening in Medicaid managed care.


OBJECTIVES: A randomized controlled trial evaluated the impact of feedback and financial incentives on physician compliance with cancer screening guidelines for women 50 years of age and older in a Medicaid health maintenance organization (HMO). METHODS: Half of 52 primary care sites received the intervention, which included written feedback and a financial bonus. Mammography, breast exam, colorectal screening, and Pap testing compliance rates were evaluated. RESULTS: From 1993 to 1995, screening rates doubled overall (from 24% to 50%), with no significant differences between intervention and control group sites. CONCLUSIONS: Financial incentives and feedback did not improve physician compliance with cancer screening guidelines in a Medicaid HMO.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (892K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • From the Centers for Disease Control and Prevention. Trends in cancer screening--United States, 1987 and 1992. JAMA. 1996 Feb 14;275(6):428–429. [PubMed]
  • Anderson LM, May DS. Has the use of cervical, breast, and colorectal cancer screening increased in the United States? Am J Public Health. 1995 Jun;85(6):840–842. [PMC free article] [PubMed]
  • Bloom JR, Grazier K, Hodge F, Hayes WA. Factors affecting the use of screening mammography among African American women. Cancer Epidemiol Biomarkers Prev. 1991 Nov-Dec;1(1):75–82. [PubMed]
  • Price JH, Desmond SM, Slenker S, Smith D, Stewart PW. Urban black women's perceptions of breast cancer and mammography. J Community Health. 1992 Aug;17(4):191–204. [PubMed]
  • Fox SA, Murata PJ, Stein JA. The impact of physician compliance on screening mammography for older women. Arch Intern Med. 1991 Jan;151(1):50–56. [PubMed]
  • Schapira DV, Pamies RJ, Kumar NB, Herold AH, Van Durme DJ, Woodward LJ, Roetzheim RG. Cancer screening. Knowledge, recommendations, and practices of physicians. Cancer. 1993 Feb 1;71(3):839–843. [PubMed]
  • Zapka JG, Stoddard AM, Costanza ME, Greene HL. Breast cancer screening by mammography: utilization and associated factors. Am J Public Health. 1989 Nov;79(11):1499–1502. [PMC free article] [PubMed]
  • Myers RE, Trock BJ, Lerman C, Wolf T, Ross E, Engstrom PF. Adherence to colorectal cancer screening in an HMO population. Prev Med. 1990 Sep;19(5):502–514. [PubMed]
  • Cheney C, Ramsdell JW. Effect of medical records' checklists on implementation of periodic health measures. Am J Med. 1987 Jul;83(1):129–136. [PubMed]
  • Chambers CV, Balaban DJ, Carlson BL, Ungemack JA, Grasberger DM. Microcomputer-generated reminders. Improving the compliance of primary care physicians with mammography screening guidelines. J Fam Pract. 1989 Sep;29(3):273–280. [PubMed]
  • McPhee SJ, Bird JA, Jenkins CN, Fordham D. Promoting cancer screening. A randomized, controlled trial of three interventions. Arch Intern Med. 1989 Aug;149(8):1866–1872. [PubMed]
  • McPhee SJ, Detmer WM. Office-based interventions to improve delivery of cancer prevention services by primary care physicians. Cancer. 1993 Aug 1;72(3 Suppl):1100–1112. [PubMed]
  • Tierney WM, Hui SL, McDonald CJ. Delayed feedback of physician performance versus immediate reminders to perform preventive care. Effects on physician compliance. Med Care. 1986 Aug;24(8):659–666. [PubMed]
  • Winickoff RN, Coltin KL, Morgan MM, Buxbaum RC, Barnett GO. Improving physician performance through peer comparison feedback. Med Care. 1984 Jun;22(6):527–534. [PubMed]
  • Egdahl RH, Taft CH. Financial incentives to physicians. N Engl J Med. 1986 Jul 3;315(1):59–61. [PubMed]
  • Hillman AL, Pauly MV, Kerman K, Martinek CR. HMO managers' views on financial incentives and quality. Health Aff (Millwood) 1991 Winter;10(4):207–219. [PubMed]
  • Hillman AL, Pauly MV, Kerstein JJ. How do financial incentives affect physicians' clinical decisions and the financial performance of health maintenance organizations? N Engl J Med. 1989 Jul 13;321(2):86–92. [PubMed]
  • Hillman AL. Financial incentives for physicians in HMOs. Is there a conflict of interest? N Engl J Med. 1987 Dec 31;317(27):1743–1748. [PubMed]
  • Greenfield S, Nelson EC, Zubkoff M, Manning W, Rogers W, Kravitz RL, Keller A, Tarlov AR, Ware JE., Jr Variations in resource utilization among medical specialties and systems of care. Results from the medical outcomes study. JAMA. 1992 Mar 25;267(12):1624–1630. [PubMed]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...