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Pay for performance for specialised care in England: Strengths and weaknesses

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  • Feng, Yan
  • Kristensen, Søren Rud
  • Lorgelly, Paula
  • Meacock, Rachel
  • Sanchez, Marina Rodes
  • Siciliani, Luigi
  • Sutton, Matt

Abstract

Pay-for-Performance (P4P) schemes have become increasingly common internationally, yet evidence of their effectiveness remains ambiguous. P4P has been widely used in England for over a decade both in primary and secondary care. A prominent P4P programme in secondary care is the Commissioning for Quality and Innovation (CQUIN) framework. The most recent addition to this framework is Prescribed Specialised Services (PSS) CQUIN, introduced into the NHS in England in 2013. This study offers a review and critique of the PSS CQUIN scheme for specialised care. A key feature of PSS CQUIN is that whilst it is centrally developed, performance targets are agreed locally. This means that there is variation across providers in the schemes selected from the national menu, the achievement level needed to earn payment, and the proportion of the overall payment attached to each scheme. Specific schemes vary in terms of what is incentivised – structure, process and/or outcome – and how they are incentivised. Centralised versus decentralised decision making, the nature of the performance measures, the tiered payment structure and the dynamic nature of the schemes have created a sophisticated but complex P4P programme which requires evaluation to understand the effect of such incentives on specialised care.

Suggested Citation

  • 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.
    • Handle: RePEc:eee:hepoli:v:123:y:2019:i:11:p:1036-1041
    DOI: 10.1016/j.healthpol.2019.07.007
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    References listed on IDEAS

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    1. Kristensen, Søren Rud & Siciliani, Luigi & Sutton, Matt, 2016. "Optimal price-setting in pay for performance schemes in health care," Journal of Economic Behavior & Organization, Elsevier, vol. 123(C), pages 57-77.
    2. Thomas Allen & Eleonora Fichera & Matt Sutton, 2016. "Can Payers Use Prices to Improve Quality? Evidence from English Hospitals," Health Economics, John Wiley & Sons, Ltd., vol. 25(1), pages 56-70, January.
    3. Alan Maynard, 2012. "The powers and pitfalls of payment for performance," Health Economics, John Wiley & Sons, Ltd., vol. 21(1), pages 3-12, January.
    4. 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.
    5. Rachel Meacock & Søren Rud Kristensen & Matt Sutton, 2014. "The Cost‐Effectiveness Of Using Financial Incentives To Improve Provider Quality: A Framework And Application," Health Economics, John Wiley & Sons, Ltd., vol. 23(1), pages 1-13, January.
    6. Campbell, S. M. & Roland, M. O. & Buetow, S. A., 2000. "Defining quality of care," Social Science & Medicine, Elsevier, vol. 51(11), pages 1611-1625, December.
    7. Milstein, Ricarda & Schreyoegg, Jonas, 2016. "Pay for performance in the inpatient sector: A review of 34 P4P programs in 14 OECD countries," Health Policy, Elsevier, vol. 120(10), pages 1125-1140.
    8. F. P. Vlaanderen & M. A. Tanke & B. R. Bloem & M. J. Faber & F. Eijkenaar & F. T. Schut & P. P. T. Jeurissen, 2019. "Design and effects of outcome-based payment models in healthcare: a systematic review," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(2), pages 217-232, March.
    9. Søren Rud Kristensen, 2017. "Financial Penalties for Performance in Health Care," Health Economics, John Wiley & Sons, Ltd., vol. 26(2), pages 143-148, February.
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    Cited by:

    1. Lu Liu & Wei Nai & Zan Yang, 2022. "Measuring the State Dependence Effect in Hospital Payment Adjustment," IJERPH, MDPI, vol. 19(21), pages 1-17, October.
    2. 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.
    3. Tzani, Dimitra & Stavrakas, Vassilis & Santini, Marion & Thomas, Samuel & Rosenow, Jan & Flamos, Alexandros, 2022. "Pioneering a performance-based future for energy efficiency: Lessons learnt from a comparative review analysis of pay-for-performance programmes," Renewable and Sustainable Energy Reviews, Elsevier, vol. 158(C).

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