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

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 quality of care recovering to pre-pandemic levels after pandemic-related declines. DESIGN AND SETTING: This study involved descriptive analysis at the practice and aggregated indicator levels in Catalonia, Spain. METHOD: Data on 37 quality-of-care indicators from 287 primary care practices (5 250 531 adults) were analysed monthly from 2019 until 2024. Financial incentives were suspended in 2020; 13 indicators were reintegrated into pay-for-performance schemes in 2021 (early-incentivised indicators), while 24 remained out of the schemes until 2023 (late-incentivised indicators). Outcomes were annual changes in indicator results and variability, and time to recover pre-pandemic care-quality levels. A multivariate Cox model estimated the effect of incentives; Κ-means clustering identified practice recovery profiles. RESULTS: In 2021, 11 (85%) of 13 of early-incentivised indicators started showing signs of recovery versus five (21%) of 24 late-incentivised indicators. By December 2024, recovery of pre-pandemic results occurred in 85% and 50% of early- and late-incentivised indicators, respectively, despite larger pandemic drops in early-incentivised indicators. Early incentivisation doubled the likelihood of recovery before 2023 (2.06 times), with effects varying by indicator type. However, many practices recovered late-incentivised indicators when they were informed only and before financial incentives resumed. Clustering revealed four practice profiles: fast recoverers, fast for incentivised, fast for informed, and slow recoverers. Smaller practices recovered more quickly and rural practices had 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 could use these findings to guide recovery strategies and strengthen resilience in primary care.