The authors received funding from the Department of Health via the National Primary Care Research and Development Centre, Centre for Health Economics (CHE), University of York and from the Chief Scientist Office of the Scottish Government Health Directorate General via the Health Economics Research Unit (HERU), University of Aberdeen. The views expressed are those of the authors and not necessarily those of the funders. Part of the article was written whilst HG and MS were visiting the Centre for Market and Public Organisation (CMPO), University of Bristol. We are grateful for comments and suggestions from two referees, the Editor, audiences at the Australian Society of Health Economics Conference in Adelaide, CHE, Dundee, CMPO, HERU, International Health Economics Association Conference in Copenhagen, Norwegian School of Economics and Business Administration, Office of Manpower Economics, Royal Economics Society Conference in Warwick, Sheffield and Sydney; and for discussions with Tim Doran, Bruce Guthrie, David Reeves and Martin Roland.
Doctor Behaviour under a Pay for Performance Contract: Treating, Cheating and Case Finding?*
Article first published online: 20 JAN 2010
© The Author(s). Journal compilation © Royal Economic Society 2010
The Economic Journal
Volume 120, Issue 542, pages F129–F156, February 2010
How to Cite
Gravelle, H., Sutton, M. and Ma, A. (2010), Doctor Behaviour under a Pay for Performance Contract: Treating, Cheating and Case Finding?. The Economic Journal, 120: F129–F156. doi: 10.1111/j.1468-0297.2009.02340.x
- Issue published online: 20 JAN 2010
- Article first published online: 20 JAN 2010
The UK National Health Service introduced a pay for performance scheme for primary care providers in 2004/5. The scheme rewarded providers for the proportion of eligible patients who received appropriate treatment. Eligible patients were those who had been reported by the provider as having the relevant disease minus those they exception reported as not suitable for treatment. Using rich provider level data, we find that differences in reported disease rates between providers, and differences in exception rates both between and within providers, suggest gaming. Faced with ratio performance indicators, providers acted on denominators as well as numerators.