Expect the unexpectedBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3571 (Published 02 September 2009) Cite this as: BMJ 2009;339:b3571
All rapid responses
Back in 2006 I reviewed Payment by Results (PbR) in South Yorkshire, the Payment by Results laboratory for England (Minney 2006). My conclusions were that PbR did not in itself drive quality, but that the right leaders were able to use PbR to drive up quality. Hospitals could choose to spend more on ward nursing, since faster recovery to health resulted in shorter length of stay (LOS), which in turn gave greater patient throughput and higher income (Scholefield H, personal communication). Community Care could develop new pathways for patients since they could be funded out of the money saved from activity not carried out in secondary care.
The latest studies 3 years later don’t contradict this (Goodlee 2009, Farrar et al 2009, Øvretveit 2009). No system will be perfect, every system will be open to gaming, no matter how complicated the system. We are reliant on appointing the leaders and staff who have the right intent, and on the whole NHS achieves this. Quality will improve because it is the "right thing to do" in publicly funded or charitable healthcare, and quality will improve in privately funded healthcare only where the patient demands it (and they often don’t). Let’s not kid ourselves that we can create a system that anticipates every possible abuse in an area as complex as healthcare
Shared Responsibility - an answer to Payment by Results: a study on behavioural and attitude change in the South Yorkshire Payment by Results Laboratory
NHS Yorkshire & Humber, published Dec 2006 http://minney.org/Payment_by_Results
Expect the unexpected
BMJ 2009;339:b3571, doi: 10.1136/bmj.b3571 (Published 2 September 2009)
Shelley Farrar, Deokhee Yi, Matt Sutton, Martin Chalkley, Jon Sussex, and Anthony Scott
Has payment by results affected the way that English hospitals provide care? Difference-in-differences analysis
BMJ 2009;339:b3047, doi: 10.1136/bmj.b3047 (Published 27 August 2009)
Dr John Øvretveit
Does improving quality save money?
Health Foundation published September 2009
Competing interests: No competing interests