Quality of care indicators - France - introduction of payment for performance by French social security

The French "Official Journal" published April 21, 2009, the conditions of a very new kind of program for private practice physicians, announced by the French Social Security, and introducing quality indicators for prevention and chronic disease, indicators that are similar to those used by the VHA. Indicators are based on the "Law of Public Health" which established indicators in 2004, but did not establish a method of enforcement. Hence the work of French Social Security, who for our American readers, could in this case be compared to Medicare/Medicaid for all. This program raises a fundamental question: how many docotrs will be motivated by the 7 euro/patient "bonus plan" and willing and able to document their results? Will it only interest those physicians who already produce quality results? Click to read more.

For French-readers, please click here for the official program "CAPI" launched on April 21 2009.
Otherwise, here is the SIlber's Blog Summary:
-- A voluntary contract will be signed between the physician and the local French social security office director. (in this case, think Medicare/Medicaid).
-- To be eligible the physician has to accept the conditions of French social security and have sufficient patients in each of the categories of prevention and care. (The physician must present the numbers)
-- Objectives:
The physician agrees to prevention and quality requirements concerning: flu vaccination, breast cancer screening, side effect prevention (reduced percent of benzodiazepines), diabetes (retina exam, HBa1) HBP, cost-effective prescriptions, ....
-Results: Following calculation of the ratio of results to number of patients followed per category, the physician will receive a financial incentive of 7 euros per patient per year. 

This is all very new. We'll be watching over time to see how many physicians sign up and how they manage to document their results, given the fact that patient records are not generally computerized in France.

The main physician union associations are not in favor of what appears to be a constraint to their freedom of choice.

Comments please?