Since 2014
Paying for improvements in quality: recent experience in the NHS in England
Nordic Journal of Health Economics
View Archive Info| Field | Value | |
| Title |
Paying for improvements in quality: recent experience in the NHS in England
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| Creator |
Meacock, Rachel; The University of Manchester, England.
Kristensen, Søren; The University of Manchester, England. Sutton, Matt; The University of Manchester, England. |
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| Subject |
Economics, Health.
pay-for-performance, quality, financial incentives I1 I18 |
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| Description |
There is a long-term international trend towards linking payments more closely to providers’ performance. The US and England have been at the forefront of the design and introduction of such pay-for-performance (P4P) schemes. England’s experience is, however, likely to have greater salience for the Nordic countries’ health care systems due to the publicly funded finance structure. We review the development of five of England’s major schemes and summarise the available evidence on their impacts. These schemes are: the Quality and Outcomes Framework (QOF); Advancing Quality; the Commissioning for Quality and Innovation (CQUIN) framework; Best Practice Tariffs; and the newest ‘non-payment’ policies. Much of the evidence is limited by the non-experimental way in which the schemes have been introduced, with limited data available prior to the introduction of the schemes and no experimentally unexposed providers to serve as controls. Nonetheless, the existing evidence suggests that P4P can result in modest short-term improvements in the incentivised aspects of performance. There is little evidence of effort diversion, yet some to suggest positive spillovers of these schemes onto non-incentivised aspects of performance. While there is some evidence of gaming and inequitable consequences, these do not appear to be widespread. The gains that can accrue across large patient populations as a result of relatively small financial incentives mean that P4P schemes can be cost-effective. P4P programmes are likely to be most effective when introduced as a supporting part to a wider quality improvement initiative, and when results are published to encourage a reputational as well as a financial incentive for improvement. Though the accumulation of evidence to support P4P has not been systematic or especially robust, it remains a popular policy tool with decision-makers in England, with its reach set to increase further in the future.
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| Publisher |
University of Oslo
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| Contributor |
—
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| Date |
2014-05-05
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| Type |
info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion Peer-reviewed Article |
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| Format |
application/pdf
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| Identifier |
https://www.journals.uio.no/index.php/NJHE/article/view/794
10.5617/njhe.794 |
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| Source |
Nordic Journal of Health Economics; Vol 2, No 1 (2014): Nordic Journal of Health Economics
1892-9710 1892-9729 |
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| Language |
eng
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| Relation |
https://www.journals.uio.no/index.php/NJHE/article/view/794/787
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| Rights |
Authors who publish with this journal agree to the following terms:Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
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