Pay-for-Performance incentives for specialised services in England: a mixed methods evaluation
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Publisher
Publisher URL
DOI
10.1007/s10198-023-01630-6
Journal
The European Journal of Health Economics
ISSN
1618-7598
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Show full item recordAbstract
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 diference-in-diferences
design to evaluate the efectiveness 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 fnancial 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 signifcant 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 fexibility.
Conclusion The PSS CQUIN schemes had little or no impact on quality improvements in specialised services. Future P4P programmes in healthcare could beneft from lessons learnt from this study on incentive design and programme implementation.
Keywords Pay-for-Performance · Financial withholds · Programme evaluation · Mixed methods · Specialised care · English
National Health Service
JEL Classifcation I12 · I18 · J33