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Doctor Behaviour under a Pay for Performance Contract: Treating, Cheating and Case Finding?

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Author Info

  • Hugh Gravelle
  • Matt Sutton
  • Ada Ma

Abstract

The UK National Health Service introduced a pay for performance scheme for primary care providers in 2004/5. The scheme rewarded providers for the proportion of eligible patients who received appropriate treatment. Eligible patients were those who had been reported by the provider as having the relevant disease minus those they exception reported as not suitable for treatment. Using rich provider level data, we find that differences in reported disease rates between providers, and differences in exception rates both between and within providers, suggest gaming. Faced with ratio performance indicators, providers acted on denominators as well as numerators. Copyright � The Author(s). Journal compilation � Royal Economic Society 2010.

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Bibliographic Info

Article provided by Royal Economic Society in its journal The Economic Journal.

Volume (Year): 120 (2010)
Issue (Month): 542 (02)
Pages: F129-F156

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Handle: RePEc:ecj:econjl:v:120:y:2010:i:542:p:f129-f156

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Citations

Blog mentions

As found by EconAcademics.org, the blog aggregator for Economics research:
  1. Sifting through data to detect deliberate misreporting in pay-for-performance schemes
    by Jed Friedman in Development Impact on 2012-10-17 09:06:37
Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
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Cited by:
  1. Eijkenaar, Frank & Emmert, Martin & Scheppach, Manfred & Schöffski, Oliver, 2013. "Effects of pay for performance in health care: A systematic review of systematic reviews," Health Policy, Elsevier, vol. 110(2), pages 115-130.
  2. Dusheiko, Mark & Gravelle, Hugh & Martin, Stephen & Rice, Nigel & Smith, Peter C., 2011. "Does better disease management in primary care reduce hospital costs? Evidence from English primary care," Journal of Health Economics, Elsevier, vol. 30(5), pages 919-932.
  3. Ratto, Marisa & Tominey, Emma & Propper, Carol & Burgess, Simon M., 2012. "Incentives in the Public Sector: Evidence from a Government Agency," Economics Papers from University Paris Dauphine 123456789/12197, Paris Dauphine University.
  4. Rita Santos & Hugh Gravelle & Carol Propper, 2013. "Does quality affect patients’ choice of doctor? Evidence from the UK," Working Papers 088cherp, Centre for Health Economics, University of York.
  5. G. Fiorentini & M. Lippi Bruni & C. Ugolini, 2012. "GPs and hospital expenditures. Should we keep expenditure containment programs alive?," Working Papers wp829, Dipartimento Scienze Economiche, Universita' di Bologna.
  6. Nolan, Anne & O'Reilly, Jacqueline & Smith, Samantha & Brick, Aoife, 2011. "The Potential Role of Pay-for-Performance in Irish Health Care," Papers EC4, Economic and Social Research Institute (ESRI).
  7. Mark Dusheiko & Hugh Gravelle & Stephen Martin & Nigel Rice & Peter C Smith, 2011. "Does Better Disease Management in Primary Care Reduce Hospital Costs?," Working Papers 065cherp, Centre for Health Economics, University of York.
  8. E. Iezzi & M. Lippi Bruni & C. Ugolini, 2011. "The role of GP’s compensation schemes in diabetes care: evidence from panel data," Working Papers wp766, Dipartimento Scienze Economiche, Universita' di Bologna.
  9. Pike, Chris, 2010. "An Empirical Analysis of the Effects of GP Competition," MPRA Paper 27613, University Library of Munich, Germany.
  10. Jeannette Brosig-Koch & Heike Hennig-Schmidt & Nadja Kairies & Daniel Wiesen, 2013. "How Effective are Pay-for-Performance Incentives for Physicians? – A Laboratory Experiment," Ruhr Economic Papers 0413, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
  11. Mark Stabile & Sarah Thomson, 2014. "The Changing Role of Government in Financing Health Care: An International Perspective," Journal of Economic Literature, American Economic Association, vol. 52(2), pages 480-518, June.

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