Financial incentives and information provision for post-pandemic primary care quality recovery: a longitudinal study in Catalonia

Abstract

Background: The COVID-19 pandemic disrupted primary care services worldwide, reducing quality-of-care. Understanding the impact of quality improvement strategies can guide system resilience. Aim: To assess whether information provision and financial incentives to primary care professionals supported recovery of pre-pandemic quality-of-care after pandemic-related declines. Design and Setting: Descriptive analysis at the primary care practice (PCP) and aggregated indicator levels in Catalonia, Spain. Method: Data on 37 quality-of-care indicators from 287 PCPs (5,250,531 adults) were analyzed monthly from 2019–2024. Financial incentives were suspended in 2020; 13 indicators were reintegrated into pay-for-performance schemes in 2021 (early-incentivised), while 24 remained unincentivised until 2023 (late-incentivised). Outcomes were annual changes in indicator results and variability, and time to recover pre-pandemic levels. A multivariate Cox model estimated the effect of incentives; K-means clustering identified PCP recovery profiles. Results: In 2021, 11/13 (85%) of early-incentivised indicators started recovering versus 5/24 (21%) of late-incentivised. By December 2024, recovery of pre-pandemic results occurred in 85% and 50%, respectively, despite larger pandemic drops in early-incentivised indicators. Early incentivization doubled the likelihood of recovery before 2023 (2.06 times), with effects varying by indicator type. However, many PCPs recovered late-incentivised indicators before incentives resumed, when only informed. Clustering revealed four PCP profiles; faster recoverers were smaller, rural practices with milder declines. Conclusion: Financial incentives accelerated quality-of-care recovery after a system shock, particularly when tailored to indicator types and practice contexts, and complemented by timely information provision. Policymakers can use these findings to guide recovery strategies and strengthen resilience in primary care.