ArticleThe European journal of health economics : HEPAC : health economics in prevention and care2024
Pay-for-Performance incentives for specialised services in England: a mixed methods evaluation.
Article in The European journal of health economics : HEPAC : health economics in prevention and care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- National Health Service consultants' experiences and views of performance pay in England: a qualitative interview study.BMJ open · 2026Article
- Does pay for performance affect socioeconomic inequalities in access? Evidence from hospital specialised care in England.Health policy (Amsterdam, Netherlands) · 2026Article
- Information provision and financial incentives in Catalonia's public primary care (2010-2019): an interrupted time series analysis.The Lancet regional health. Europe · 2024Article
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Authors and funding
8 authors.
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Abstract
backgroundA 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.
methodsWe used a mixed methods evaluative approach. In the quantitative analysis, we used a difference-in-differences design to evaluate the effectiveness 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 financial 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.
resultsThe ten PSS CQUIN schemes had limited impact on the targeted outcomes. A statistically significant 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 flexibility.
conclusionThe PSS CQUIN schemes had little or no impact on quality improvements in specialised services. Future P4P programmes in healthcare could benefit from lessons learnt from this study on incentive design and programme implementation.
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