News Video | Policy | GPs | Hospitals | Medical | Mental Health | Welfare | Search

 


Future of healthcare pay-for-performance schemes in doubt

Future of healthcare pay-for-performance schemes thrown into doubt

The effectiveness of the widespread use of pay-for-performance schemes in hospitals has been thrown into doubt by new research revealing reductions in patient death rates are just a short-term effect.

Researchers followed up an initial study of 24 hospitals in the north west of England that found it had reduced the number of deaths by 890 in the first 18 months of a pay-for-performance scheme being introduced.

But two years later the scheme’s impact on improving figures for in-hospital deaths within 30 days of admission had disappeared.

The ‘Advancing Quality’ scheme used in the north west sees cash bonuses paid to the top-performing hospitals to invest in further improvements in care, though midway through the programme this was changed to fines for failing to reach targets.

Warwick Business School Professor Ruth McDonald was part of the research team that included academics from the University of Manchester and the University of Cambridge.

She said: “The results are quite ambiguous. We found that the effect was no longer present at 42 months, but then we also found improvements in related areas, where there was an improvement in the quality of care for patients not covered by the incentive scheme.

“Also, the effect no longer being there may be because the rest of the country had taken on the lessons from the pay-for-performance scheme used in the north west, but we really don’t know and need to do more research to find out.

“Potentially the change to fines rather than bonuses could make a difference, but we didn’t find any evidence that people were treated differently. The system changed but from the interviews we did people took the scheme just as seriously.”

The study, funded by the National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR) Programme published in the New England Journal of Medicine, looked at three conditions for which patients are admitted to hospital in an emergency; heart attack, pneumonia, and heart failure. Researchers examined deaths occurring within 30 days of admission to hospital, comparing the 24 hospitals in the north west with 137 in the rest of England. In all more than 1.8 million admissions were looked at.

Professor McDonald added: “Pay-for-performance schemes are being widely adopted in hospitals, so it is important we understand what impact they are having.

“After showing positive short-term effects, in the long-term, although death rates in the north west continued to fall, the reductions were no longer better than the national trend. In fact the reduction in mortality among patients with the conditions studied was greater in the hospitals not participating in the programme. Yet the mortality rate for related conditions not covered by the scheme fell more in the participating hospitals, raising the possibility of positive spillover effects on care for other conditions.

“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, entitled Long-Term Effect of Hospital Pay for Performance on Mortality in England, was authored by Søren Rud Kristensen, Rachel Meacock, Alex James Turner, Ruth Boaden and Matt Sutton, of the University of Manchester, Ruth McDonald, of Warwick Business School and Martin Roland, of the University of Cambridge.

For a copy of the paper contact Ashley Potter at ashley.potter@wbs.ac.uk.

ends

© Scoop Media

 
 
 
 
 
Culture Headlines | Health Headlines | Education Headlines

 

Snell Sale Peters Out: Singlet Withdrawn From Sale

“We believe the item was offered for sale in good faith, but our inquiries have shown that the singlet is not the one worn by Peter Snell at the 1964 Tokyo Olympic Games.” More>>

ALSO:

Bodega: Venue Closing At The End Of The Year, After 25 Years Of Music

"It is with considerable sadness that, for reasons beyond our control, we regret to announce the closure of Bodega’s doors at the end of this year, after 25 years of faithful and committed service to live music in Wellington." More>>

Scoop Review Of Books: Women At The Centre

In the first chapter of her epic History of New Zealand Women, Barbara Brookes places a version of the Māori creation story alongside that of the Pākehā colonists, setting the scene for how each society saw women. The contrast is startling. More>>

In Auckland Art Gallery: A Tour Of Duty

I had already started my journey through the exhibited collections when an audio announcement about a guided tour to embark shortly from the foyer was made, I decided to join in. Why not? More>>

Art: ‘Holiday’ Wins IHC Art Awards

An intricate embroidered cushion by Wellington artist Jo-Anne Tapiki has won the 2016 IHC Art Awards and $5000. Jo-Anne started working from IHC’s Arts on High studio in Lower Hutt 18 months ago and this is the first time she has entered the competition. More>>

‘Quasi’: Christchurch Art Gallery Reveals Rooftop Sculpture

Christchurch-born and internationally renowned artist Ronnie van Hout has had a huge hand in Christchurch Art Gallery's latest outdoor installation. More>>

Get More From Scoop

 
 

LATEST HEADLINES

 
 
 
 
Health
Search Scoop  
 
 
Powered by Vodafone
NZ independent news