Pay-for-performance schemes only reduce patient death rates in the short term, finds new research

Pay-for-performance schemes - which reward hospitals financially for improving the quality of care provided to patients - only reduce patient death rates in the short term, according to new research by The University of Manchester.

A variety of programmes have been introduced in the UK over the past decade, with mixed results. Advancing Quality, a programme imported from the United States, was the first of these schemes to demonstrate a significant reduction in patient deaths.

It was introduced in the North West region of England in 2008. Previous research conducted at The University of Manchester showed Advancing Quality to have reduced patient deaths by 890 in the first 18 months of the policy's introduction.

But new research funded by the National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR) Programme published in the New England Journal of Medicine today demonstrates that while the quality of care continued to increase over the following two years, there was no further reduction in patient deaths in the region covered by the programme over that observed in the rest of England.

The study, looked at three conditions for which patients are admitted to hospital in an emergency; heart attack, pneumonia, and heart failure. Researchers from the University's Faculty of Medical and Human Sciences and Manchester Business School, along with the University of Warwick and University of Cambridge, examined deaths occurring within 30 days of admission to hospital, comparing the 24 hospitals in the North West with 137 in the rest of England.

Professor Matt Sutton, from The University of Manchester who led the previous study, said: "The earlier work found significant reductions in death rates in the short-term. Our latest research shows that in the longer-term, although death rates in the North West continued to fall, the reductions for the conditions linked to the incentives were no longer larger than the national trend."

Dr S-ren Rud Kristensen, from The University of Manchester who led the current study, added: "These results suggest that the benefits of initiatives such as paying for performance may be temporary. Our findings could also be explained by the decision taken midway through the programme to change the incentives from bonuses for good performance to fines for failing to achieve targets.

"But we also found evidence to suggest that unintended but desirable spill-over effects may have occurred. These include improvements in the quality of care provided to both patients treated in hospitals in other regions, as well as patients admitted in the North West for conditions not covered by the incentive programme."