Letters Payment by results

Market failure

BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b3859 (Published 22 September 2009) Cite this as: BMJ 2009;339:b3859
  1. Rudiger Pittrof, consultant in integrated sexual health and HIV1
  1. 1Enfield Community Services, Enfield EN1 1NJ
  1. Rudiger.Pittrof{at}enfield.nhs.uk

    Payment by results was intended to enable commissioners and providers to focus and compete on quality rather than costs. Farrar and colleagues showed that quality (as measured) did not change.1 Perhaps the healthcare market cannot be used to improve quality, payment by results is the wrong tool to improve quality, or the assessment of quality was inadequate, or all three.

    Farrar and colleagues showed a small improvement in productivity. This may be more than offset by the additional administrative costs for both commissioners and providers.

    They found no change in case mix. Indeed, the increased number of day case procedures may reflect, overall, that healthier patients receive treatment. In sexual health, for example, payment by results rewards providing minimal services for the worried well while penalising targeting those who have most to gain from using the services—the most expensive patients.


    Cite this as: BMJ 2009;339:b3859


    • Competing interests: None declared.


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