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'Pay-for-performance may not improve care'

'Pay-for-performance may not improve care'


Pay-for-performance schemes for hospitals are of questionable benefit to patients, researchers have revealed. 

When looking at 24 hospitals in north west England, researchers found there were 890 fewer deaths in the first 18 months of a pay-for-performance scheme being introduced. 

But after two years, the scheme’s impact on improving in-hospital death rates had disappeared, the Warwick Business School study found. 

A total of 1.8 million hospital admissions for emergencies, heart attack, pneumonia and heart failure were examined. Death rates within 30 days of hospital admission were compared to the rest of the hospitals in England. 

At the start of the study cash bonuses were given to the top-performing hospitals to invest in care improvements (‘Advancing Quality’). However, halfway through the study this was changed to fines for failing to reach targets.

The reduction in mortality was greater in hospitals not participating in the programme, over the same period of time. But the mortality rate for related conditions not included in the scheme fell more in participating hospitals. 

Researchers raised the possibility of “positive spillover effects” on care for other conditions. 

Professor Ruth McDonald was part of the research team at Warwick Business School. She said the results are “quite ambiguous”. 

“Potentially the change to fines rather than bonuses could make a difference but we didn’t find any evidence that people were treated differently,” she said. 

Professor McDonald added: “Pay-for-performance schemes are being widely adopted in hospitals across the country, so it is important we understand the impact they’re having. More research is needed to understand just how and why the short-term positive effect has disappeared and why these apparent spillover effects have occurred.” 

The paper was published in the New England Journal of Medicine and funded by the National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR). 


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