for example if they directly reward evidencebased preventative medicine and other actions designed to reduce future demands for health services they may serve to promote the costeffectiveness of the health system if on the other hand they offer no reward for timely intervention and mitigation of future illhealth the financial incentives may be dysfunctional and serve to exacerbate cost pressures for example by encouraging referral for unnecessary specialist diagnostic tests or indeed by discouraging necessary referrals and thereby increasing future healthcare costs in the same vein nonfinancial instruments most notably performance reporting requirements might reinforce or work against cost containment objectives depending upon their design the next section examines three fundamental functions of primary care that may contribute to this objective reducing or delaying the onset of disease reducing the use of specialist care once a clinical condition has been identified and reducing the intensity of use of specialist care once a need for such care has arisen