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Doctor Behaviour Under a Pay for Performance Contract: Further Evidence from the Quality and Outcomes Framework

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Author Info

  • Hugh Gravelle

    (National Primary Care Research & Development Centre, Centre for Health Economics, University of York)

  • Matt Sutton

    (Health Economics Research Unit, University of Aberdeen)

  • Ada Ma

    (Health Economics Research Unit, University of Aberdeen)

Abstract

Since 2003, 25% of UK general practitioners’ income has been determined by the quality of their care. The 65 clinical quality indicators in this scheme (the Quality and Outcomes Framework) are in the form of ratios, with financial reward increasing linearly with the ratio between a lower and upper threshold. The numerator is the number of patients for whom an indicator is achieved and the denominator is the number of patients the practices declare are suitable for the indicator. The number declared suitable is the number of patients with the relevant condition less the number exception reported by the practice for a specified range of reasons. Exception reporting is designed to avoid harmful treatment resulting from the application of quality targets to patients for whom they were not intended. However, exception reporting also gives GPs the opportunity to exclude patients who should in fact be treated in order to achieve higher financial rewards. This is inappropriate use of exception reporting or ‘gaming’. Practices can also increase income if they are below the upper threshold by reducing the number of patients declared with a condition (prevalence), or by increasing reported prevalence if they were above the upper threshold. This study examines the factors affecting delivered quality (the proportion of prevalent patients for indicators were achieved) and tests for gaming of exceptions and for prevalence reporting being responsive to financial incentives.

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File URL: http://www.york.ac.uk/media/che/documents/papers/researchpapers/rp34_doctor_behavior_under_a_pay_for_performance_contract_further_evidence.pdf
File Function: First version, 2007
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Bibliographic Info

Paper provided by Centre for Health Economics, University of York in its series Working Papers with number 034cherp.

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Length: 37 pages
Date of creation: Feb 2008
Date of revision:
Handle: RePEc:chy:respap:34cherp

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Related research

Keywords: Quality. Incentives. Gaming. Pay for performance.;

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Cited by:
  1. Anthony Scott & Stefanie Schurer & Paul H. Jensen & Peter Sivey, 2009. "The effects of an incentive program on quality of care in diabetes management," Health Economics, John Wiley & Sons, Ltd., vol. 18(9), pages 1091-1108.
  2. Stephen Morris & Rosalind Goudie & Matt Sutton & Hugh Gravelle & Robert Elliott & Arne Risa Hole & Ada Ma & Bonnie Sibbald & Diane Skåtun, 2011. "Determinants of general practitioners' wages in England," Health Economics, John Wiley & Sons, Ltd., vol. 20(2), pages 147-160, 02.
  3. Kaarboe, Oddvar Martin & Siciliani, Luigi, 2008. "Multitasking, Quality and Pay for Performance," CEPR Discussion Papers 6911, C.E.P.R. Discussion Papers.
  4. Matt Sutton & Ross Elder & Bruce Guthrie & Graham Watt, 2010. "Record rewards: the effects of targeted quality incentives on the recording of risk factors by primary care providers," Health Economics, John Wiley & Sons, Ltd., vol. 19(1), pages 1-13.
  5. Matt Sutton & Ross Elder & Bruce Guthrie & Graham Watt, 2008. "Record rewards: the effect on risk factor monitoring of new financial incentives for UK general practices," Health, Econometrics and Data Group (HEDG) Working Papers 08/21, HEDG, c/o Department of Economics, University of York.
  6. Samson, Anne-Laure, 2009. "Faut-il remettre en cause le paiement à l’acte des médecins ?," Economics Papers from University Paris Dauphine 123456789/4872, Paris Dauphine University.
  7. Anthony Scott & Stefanie Schurer & Paul H. Jensen & Peter Sivey, 2008. "The Effect of Financial Incentives on Quality of Care: The Case of Diabetes," Melbourne Institute Working Paper Series wp2008n12, Melbourne Institute of Applied Economic and Social Research, The University of Melbourne.

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