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

A variety of pay-for-performance arrangements have been introduced in the UK over the past decade, with mixed results, says the study, which is published in the current New England Journal of Medicine (NEJM). Advancing Quality, a programme imported from the US and introduced in the north-west of England in 2008, was the first such scheme to demonstrate a significant reduction in patient deaths, and previous research by university showed that Advancing Quality had reduced patient deaths by 890 in the first 18 months of the policy’s introduction. 

However, the new study 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 compared to that observed in the rest of England.

The new work looked at three conditions for which patients are admitted to hospital in an emergency – heart attack, pneumonia and heart failure. Researchers 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.

While the earlier work had found significant reductions in death rates in the short term, the latest study shows that, longer-term, while 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, noted Professor Matt Sutton of The University of Manchester, who led the previous study.

“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,” added Soren Rud Kristensen, also from the university and who led the current study. 

However, the research 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,” said Dr Kristensen.

The research was funded by the National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR).