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Payment by results works against integrated care and needs to be replaced

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d2135 (Published 01 April 2011) Cite this as: BMJ 2011;342:d2135
  1. Nigel Hawkes
  1. 1London

The payment by results system in the NHS in England is a major obstacle to the creation of integrated care in the NHS, a conference at the King’s Fund in London on 31 March was told. The system, designed to increase the work rate in hospitals and eliminate waiting lists by paying hospitals per activity, has worked successfully in the past but now provided perverse incentives and needed to change.

Chris Ham, director of the King’s Fund, said, “PbR [payment by results] is past its sell-by date. It’s no longer fit for purpose. We need a system of payment based on capitation, plus some incentives to improve quality.”

He was summing up one of the principal themes to emerge from the conference: that paying hospitals per consultant episode led to too many admissions, when better and cheaper care might be provided outside …

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