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- Its primary care scope, excluding hospitals
- Disinclusion of cost containment among its objectives
- Ample financial incentives to practices to amassing points
- The following steep increase in the NHS’s costs, making cutting or ending the
program risky for future governments.
Reports about P4P initiatives from America talk about “gaming the system” – a
sport that the administrative bureaucracy even of schemes lean on great concepts
and requests will often be a loser.
Regardless, although it will take time to see if the outcomes of QOF related to
hypertension match the pronouncements of its advocates, it represents a noteworthy
attempt to create a new incentive structure for preventative care.
Public Policies for Prevention and Treatment of RHT
in Developing Countries Compared to Developed Countries
The low level of awareness of hypertension in developing countries is alarming, and
outcomes relating to its treatment and control are no better. Most studies about per-
ceptions of hypertension in these countries show that a mere third or so of their
hypertensive population were aware of their condition at the beginning of the study
[ 48 – 50 ], a rate which is as low as 18% in some areas [ 51 ]. Yet, for whatever reason,
this form of self-knowledge is a challenge even in parts of developed countries, for
example, Australia, where even with improved rates of screening, some poorer areas
still report an awareness of their status among only approximately one-third of
hypertensive patients [ 52 ]. Complicating the situation, in the developing world, the
proportion of known hypertensive patients who have controlled the situation is still
low [ 53 ]; a study of six middle-income nations reported that control rates were
especially low among adult men. In Africa, few countries have a rate of control
among hypertensive patients higher than 5% – Gabon reaches 5.6% [ 54 ], while one
study from Tanzania reported that fewer than 1% of patients with hypertension had
BP readings beneath 140/90 mmHg [ 55 ]. One way to account for these low rates of
awareness and control is that national policy-makers across the developing world
may underestimate or misunderstand the threat from noncommunicable diseases,
which may be new threats in rapidly changing societies. Undeniably caused at least
in part by a shortage of resources for health care, the bigger problem may some-
times be poor prioritization or a lack of medium- to long-term planning, leading to
a lack of such basic elements of primary care detection and monitoring as a basic
sphygmomanometer. Unfortunately, even when a sphygmomanometer is available,
in large parts of the developing world, blood pressure is not measured routinely at
primary care checkups. One explanation could be that practitioners are more alert to
dramatic complaints such as trauma, infectious disease, or complications of preg-
nancy. Nonetheless, the threshold among primary care practitioners in middle- and
low-income countries is known to be quite low [ 56 ]. Innovative new data compiled
N. Keles et al.