The cost-effectiveness of using financial incentives to improve provider quality: a framework and application

R. Meacock, Søren Rud Kristensen, M. Sutton

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Abstrakt

Despite growing adoption of pay-for-performance (P4P) programmes in health care, there is remarkably little evidence on the cost-effectiveness of such schemes. We review the limited number of previous studies and critique the frameworks adopted and the narrow range of costs and outcomes considered, before proposing a new more comprehensive framework, which we apply to the first P4P scheme introduced for hospitals in England. We emphasise that evaluations of cost-effectiveness need to consider who the residual claimant is on any cost savings, the possibility of positive and negative spillovers, and whether performance improvement is a transitory or investment activity. Our application to the Advancing Quality initiative demonstrates that the incentive payments represented less than half of the £13m total programme costs. By generating approximately 5200 quality-adjusted life years and £4.4m of savings in reduced length of stay, we find that the programme was a cost-effective use of resources in its first 18 months.

OriginalsprogEngelsk
TidsskriftHealth Economics
Vol/bind23
Udgave nummer1
Sider (fra-til)1-13
ISSN1057-9230
DOI
StatusUdgivet - jan. 2014

Bibliografisk note

ISI Document Delivery No.: 270BT Times Cited: 4 Cited Reference Count: 30 Meacock, Rachel Kristensen, Soren Rud Sutton, Matt National Institute for Health Research Health Services and Delivery Research (NIHR HSDR) programme [08/1809/250] This project was funded by the National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR) programme (project number 08/1809/250). Visit the HS&DR website for more information. The views and opinions expressed are those of the authors and do not necessarily reflect those of the HS&DR programme, NIHR, NHS or the Department of Health. We are grateful to Lesley Kitchen and Jane Harper of the Advancing Quality Alliance (http://www.advancingqualityalliance.nhs.uk/) for providing the data on the costs of the Advancing Quality programme and to participants in the UK Health Economists' Study Group in Oxford in June 2012 and a seminar at the University of York for their comments. 4 WILEY-BLACKWELL HOBOKEN HEALTH ECON

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