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

English National Health Service Financial withholds Mixed methods Pay-for-Performance Programme evaluation Specialised care

Journal

The European journal of health economics : HEPAC : health economics in prevention and care
ISSN: 1618-7601
Titre abrégé: Eur J Health Econ
Pays: Germany
ID NLM: 101134867

Informations de publication

Date de publication:
13 Oct 2023
Historique:
received: 24 02 2023
accepted: 11 09 2023
medline: 13 10 2023
pubmed: 13 10 2023
entrez: 13 10 2023
Statut: aheadofprint

Résumé

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. 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. 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. 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.

Sections du résumé

BACKGROUND 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 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 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 CONCLUSIONS
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.

Identifiants

DOI: 10.1007/s10198-023-01630-6 PMID: 37831298
pubmed: 37831298
doi: 10.1007/s10198-023-01630-6
pii: 10.1007/s10198-023-01630-6
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Subventions

Organisme : National Institute for Health and Care Research
ID : PR-R18-0117-22001

Informations de copyright

© 2023. The Author(s).

Références

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Auteurs

Yan Feng (Y)

Centre for Evaluation and Methods, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, Whitechapel, London, E1 2AB, UK. yan.feng@qmul.ac.uk.

Søren Rud Kristensen (SR)

Institute of Global Health Innovation, Imperial College London, London, UK.
Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark.

Paula Lorgelly (P)

Faculty of Medical and Health Sciences and School of Business, University of Auckland, Auckland, New Zealand.
Department of Applied Health Research, University College London, London, UK.

Rachel Meacock (R)

Health Organisation, Policy and Economics, University of Manchester, Manchester, UK.

Alberto Núñez-Elvira (A)

Institute of Global Health Innovation, Imperial College London, London, UK.

Marina Rodés-Sánchez (M)

Office of Health Economics, London, UK.

Luigi Siciliani (L)

Department of Economics and Related Studies, University of York, York, UK.

Matt Sutton (M)

Health Organisation, Policy and Economics, University of Manchester, Manchester, UK.

Classifications MeSH