In 2004, after a series of national initiatives associated with marked improvements in the quality care, National Health Service United Kingdom introduced pay-for-performance contract for family practitioners. This increases existing income according to performance respect 146 indicators covering clinical care 10 chronic diseases, organization and patient experience.We analyzed data extracted automatically from computing systems 8105 practices England first year program (April 2004 through...

<b>Objectives</b> To determine the impact on outcomes in patients of Evercare approach to case management elderly people. <b>Design</b> Practice level before and after analysis hospital admissions data with control group. <b>Setting</b> Nine primary care trusts England that, 2003-5, piloted people selected as being at high risk emergency admission. <b>Main outcome measures</b> Rates admission, bed days, mortality from April 2001 March 2005 62 practices 6960-7695 (depending carried out)....

Discounting costs and health benefits in cost-effectiveness analysis has been the subject of recent debate - some authors suggesting a common rate for both others lower health. We show how these views turn on key judgments fact value: whether social objective is to maximise discounted outcomes or present consumption value health; budget care fixed; expected growth threshold; demonstrate that if fixed decisions are based incremental cost effectiveness ratios (ICERs), discounting gains at same...

In the English pay-for-performance program, physicians use a range of criteria to exclude individual patients from quality calculations that determine their pay. This process, which is called exception reporting, intended safeguard against inappropriate treatment by seeking maximize income. However, reporting may allow inappropriately for whom targets have been missed (a practice known as gaming).

Journal Article Doctor Behaviour under a Pay for Performance Contract: Treating, Cheating and Case Finding? Get access Hugh Gravelle, Gravelle University of York Search other works by this author on: Oxford Academic Google Scholar Matt Sutton, Sutton Manchester Ada Ma Aberdeen The Economic Journal, Volume 120, Issue 542, 1 February 2010, Pages F129–F156, https://doi.org/10.1111/j.1468-0297.2009.02340.x Published: 20 January 2010

The implications of hospital quality competition depend on what type affects choice hospital. Previous studies and hospitals have used crude measures such as mortality readmission rates rather than the health gain from specific treatments. We estimate multinomial logit models by patients undergoing hip replacement surgery in English NHS to test whether demand responds measured detailed patient reports before after replacement. find that a one standard deviation increase average increases up...

<b>Objective</b> To estimate the impact of a national primary care pay for performance scheme, Quality and Outcomes Framework in England, on emergency hospital admissions ambulatory sensitive conditions (ACSCs). <b>Design</b> Controlled longitudinal study. <b>Setting</b> English National Health Service between 1998/99 2010/11. <b>Participants</b> Populations registered with each 6975 family practices England. <b>Main outcome measures</b> Year specific differences trend adjusted admission...

Reforms giving users of public services choice provider aim to improve quality. But such reforms will work only if quality affects provider. We test this crucial prerequisite in the English health care market by examining 3.4 million individuals family doctor. Family doctor practices provide primary and control access non-emergency hospital care, their clinical is measured published free. In setting, should affect choice. find that a 1 standard deviation increase would practice size around 17%.

<h3>Abstract</h3> <b>Objective:</b> To investigate the impact of factors outside control primary care on performance indicators proposed as measures quality care. <b>Design:</b> Multiple regression analysis relating admission rates standardised for age and sex asthma, diabetes, epilepsy to socioeconomic population characteristics supply secondary resources. <b>Setting:</b> 90 family health services authorities in England, 1989-90 1994-5. <b>Results:</b> At authority level characteristics,...

Abstract When health effects can be valued in monetary terms, as cost–benefit analysis, they should discounted at the same rate costs. If are measured quantities (e.g. quality adjusted life years) cost‐effectiveness analysis (CEA) and value of is increasing over time, discounting volume a lower than costs valid method taking account increase future effects. We show that Keeler–Cretin paradox, often used an argument against costs, has no relevance for choice discount CEA. present...

<h3>Abstract</h3> <b>Objective</b> To determine the subsequent pattern of emergency admissions in older people with a history frequent admissions. <b>Design</b> Analysis routine data from NHS hospitals using hospital episode statistics (HES) England. <b>Subjects</b> Individual patients aged  65, 75, and 85 who had at least two 1997-8. <b>Main outcome measures</b> Emergency bed use this "high risk" cohort were counted for next five years compared general population same age. No account was...

<h3>Abstract</h3> <b>Objective:</b> To assess the extent to which observed associations at population level between income inequality and mortality are statistical artefacts. <b>Design:</b> Indirect "what if" simulation by using risks of individual as a function construct hypothetical state specific for age sex if artefact argument were 100% correct. <b>Setting:</b> Data from 1990 census 50 US states plus Washington, DC, used distributions age, sex, state, range; data disaggregated Centers...

Abstract We test the relative income hypothesis that an individual's health depends on distribution of in a reference group, as well individual. use data 231 208 individuals Great Britain from 19 rounds General Household Survey between 1979 and 2000. Results are insensitive to measure self‐assessed used but sign significance effect depend group (national or regional) (Gini coefficient, absolute proportional difference mean, Yitzhaki deprivation affluence). Only one model (relative measured...

Abstract Hospital bed‐blocking occurs when hospital patients are ready to be discharged a nursing home, but no place is available, so that care acts as more costly substitute for long‐term care. We investigate the extent which greater supply of home beds or lower prices can reduce using new Local Authority (LA) level administrative data from England on delayed discharges in 2009–2013. The results suggest respond availability beds, effect modest: an increase by 10% (250 additional per LA)...

Objective. To investigate the association between indicators of quality diabetic management in English family practices and emergency hospital admissions for short‐term complications diabetes. Study Setting. A total 8,223 from 2001/2002 to 2006/2007. Design. Multiple regression analyses associations proportions practice patients with good (glycated hemoglobin [HbA1c] ≤7.4 percent) moderate (7.4 percent &lt;HbA1c ≤10 glycemic control. Covariates included diabetes prevalence, baseline...

We investigate (a) how patient choice of hospital for elective hip replacement is influenced by distance, quality and waiting times, (b) differences in choices between patients urban rural locations, (c) the relationship hospitals' elasticities demand to number local rivals, these changed after relaxation constraints on England 2006. Using a data set over 500,000 period 2002 2013 we find that became more likely travel provider with higher or lower proportion bypassing their nearest increased...

Comorbidity is increasingly common in primary care. The cost implications for patient care and budgetary management are unclear.To investigate whether caring patients with specific disease combinations increases or decreases costs compared treating separate one condition each.Retrospective observational study using data on 86 100 the General Practice Research Database.Annual was estimated each including consultations, medication, investigations. Patients comorbidity were defined as those a...

We examine whether a hospital's quality is affected by the provided other hospitals in same market. first sketch theoretical model with regulated prices and derive conditions on demand cost functions which determine hospital will increase its if rivals their quality. then apply spatial econometric methods to sample of English 2009–10 set 16 measures including mortality rates, readmission, revision redo three patient reported indicators, relationship between hospitals. find that positively...

This study provides an overview of policies affecting competition amongst hospitals and GPs in five European countries: France, Germany, Netherlands, Norway Portugal. Drawing on the empirical evidence described case studies, we find both similarities differences approaches adopted. Constraints patients' choices provider have been relaxed but countries differ amount type information that is provided public domain. Hospitals are increasingly paid via fixed prices per patient to encourage them...