Gravelle, H. orcid.org/0000-0002-7753-4233, Sutton, M. and Ma, A. (2008) Doctor behaviour under a pay for performance contract:Further evidence from the quality and outcomes framework. Working Paper. CHE Research Paper . Centre for Health Economics, University of York , York, UK.
Abstract
Since 2003, 25% of UK general practitioners’ income has been determined by the quality of their care. The 65 clinical quality indicators in this scheme (the Quality and Outcomes Framework) are in the form of ratios, with financial reward increasing linearly with the ratio between a lower and upper threshold. The numerator is the number of patients for whom an indicator is achieved and the denominator is the number of patients the practices declare are suitable for the indicator. The number declared suitable is the number of patients with the relevant condition less the number exception reported by the practice for a specified range of reasons. Exception reporting is designed to avoid harmful treatment resulting from the application of quality targets to patients for whom they were not intended. However, exception reporting also gives GPs the opportunity to exclude patients who should in fact be treated in order to achieve higher financial rewards. This is inappropriate use of exception reporting or ‘gaming’. Practices can also increase income if they are below the upper threshold by reducing the number of patients declared with a condition (prevalence), or by increasing reported prevalence if they were above the upper threshold. This study examines the factors affecting delivered quality (the proportion of prevalent patients for indicators were achieved) and tests for gaming of exceptions and for prevalence reporting being responsive to financial incentives.
Metadata
Item Type: | Monograph |
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Authors/Creators: |
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Dates: |
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Institution: | The University of York |
Academic Units: | The University of York > Faculty of Social Sciences (York) > Centre for Health Economics (York) The University of York > Faculty of Social Sciences (York) > Centre for Health Economics (York) > CHE Research Papers (York) |
Depositing User: | Pure (York) |
Date Deposited: | 19 Dec 2018 08:40 |
Last Modified: | 16 Oct 2024 11:33 |
Status: | Published |
Publisher: | Centre for Health Economics, University of York |
Series Name: | CHE Research Paper |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:140186 |