The Quality and Outcomes Framework: Body commodification in UK general practice. (December 2016)

• Record Type: Journal Article
• Authors: Norman, Armando H.; Russell, Andrew J.; Merli, Claudia
• Is Part Of: Social science & medicine. Volume 170(2016)
• Page Start: 77
• Page End: 86
• Publication Date: 2016-12
• Subjects: Commodification -- Pay-for-Performance -- Health technology -- Health policy -- Clinical governance -- Audit culture -- General practice -- United Kingdom; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2016.10.009
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: The UK's Quality and Outcomes Framework (QOF) is the largest pay-for-performance scheme in the world. This ethnographic study explored how QOF's monetary logic influences the approach to healthcare in UK general practice. From August 2013 to April 2014, we researched two UK general practice surgeries and one general practice training programme. These environments provided the opportunity for studying various spaces such as QOF meetings, consultation rooms, QOF recoding sessions, and the collection of computer-screen images depicting how patients' biomarkers are evaluated and costed through software systems. QOF as a biomedical technology has led to the commodification of patients and their bodies. This complex phenomenon breaks down into three main themes: commodification of patients, QOF as currency, and valuing commodities. Despite the ostensible aim of QOF being to improve healthcare in general practice, it is accompanied by a body commodification process. The interface between patients and care providers has been commodified, with QOF's pricing mechanism and fragmentation of care provision performing an important role in animating the UK economy. Highlights: Argues that commodification in general practice has moved from conceptual to literal. Reveals patients as collections of abstracted biomarkers to be exchanged for money. Demonstrates QOF's strong seasonal effects on practice organisation and patient care. Discusses QOF's potential biomedicalization process in primary care. Shows the conflict of interest embedded in this type of payment modality.