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Pay-for-Performance incentives for specialised services in England: a mixed methods evaluation

Author

Listed:
  • Yan Feng

    (Queen Mary University of London)

  • Søren Rud Kristensen

    (Imperial College London
    University of Southern Denmark)

  • Paula Lorgelly

    (University of Auckland
    University College London)

  • Rachel Meacock

    (University of Manchester)

  • Alberto Núñez-Elvira

    (Imperial College London)

  • Marina Rodés-Sánchez

    (Office of Health Economics)

  • Luigi Siciliani

    (University of York)

  • Matt Sutton

    (University of Manchester)

Abstract

Background A Pay-for-Performance (P4P) programme, known as Prescribed Specialised Services Commissioning for Quality and Innovation (PSS CQUIN), was introduced for specialised services in the English NHS in 2013/2014. These services treat patients with rare and complex conditions. We evaluate the implementation of PSS CQUIN contracts between 2016/2017 and 2018/2019. Methods We used a mixed methods evaluative approach. In the quantitative analysis, we used a difference-in-differences design to evaluate the effectiveness of ten PSS CQUIN schemes across a range of targeted outcomes. Potential selection bias was addressed using propensity score matching. We also estimated impacts on costs by scheme and financial year. In the qualitative analysis, we conducted semi-structured interviews and focus group discussions to gain insights into the complexities of contract design and programme implementation. Qualitative data analysis was based on the constant comparative method, inductively generating themes. Results The ten PSS CQUIN schemes had limited impact on the targeted outcomes. A statistically significant improvement was found for only one scheme: in the clinical area of trauma, the incentive scheme increased the probability of being discharged from Adult Critical Care within four hours of being clinically ready by 7%. The limited impact may be due to the size of the incentive payments, the complexity of the schemes’ design, and issues around ownership, contracting and flexibility. Conclusion The PSS CQUIN schemes had little or no impact on quality improvements in specialised services. Future P4P programmes in healthcare could benefit from lessons learnt from this study on incentive design and programme implementation.

Suggested Citation

  • Yan Feng & Søren Rud Kristensen & Paula Lorgelly & Rachel Meacock & Alberto Núñez-Elvira & Marina Rodés-Sánchez & Luigi Siciliani & Matt Sutton, 2024. "Pay-for-Performance incentives for specialised services in England: a mixed methods evaluation," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 25(5), pages 857-876, July.
    • Handle: RePEc:spr:eujhec:v:25:y:2024:i:5:d:10.1007_s10198-023-01630-6
    DOI: 10.1007/s10198-023-01630-6
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    References listed on IDEAS

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    1. Ogundeji, Yewande Kofoworola & Bland, John Martin & Sheldon, Trevor Andrew, 2016. "The effectiveness of payment for performance in health care: A meta-analysis and exploration of variation in outcomes," Health Policy, Elsevier, vol. 120(10), pages 1141-1150.
    2. Feng, Yan & Kristensen, Søren Rud & Lorgelly, Paula & Meacock, Rachel & Sanchez, Marina Rodes & Siciliani, Luigi & Sutton, Matt, 2019. "Pay for performance for specialised care in England: Strengths and weaknesses," Health Policy, Elsevier, vol. 123(11), pages 1036-1041.
    3. Emma McManus & Jack Elliott & Rachel Meacock & Paul Wilson & Judith Gellatly & Matt Sutton, 2021. "The effects of structure, process and outcome incentives on primary care referrals to a national prevention programme," Health Economics, John Wiley & Sons, Ltd., vol. 30(6), pages 1393-1416, June.
    4. Frank Eijkenaar, 2013. "Key issues in the design of pay for performance programs," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(1), pages 117-131, February.
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    Keywords

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    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • J33 - Labor and Demographic Economics - - Wages, Compensation, and Labor Costs - - - Compensation Packages; Payment Methods

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