title: The UK pay-for-performance programme in primary care: estimation of population mortality reduction.
abstract: BACKGROUND
  General practices in the UK contract with the government to receive additional payments for high-quality primary care. Little is known about the resulting impact on population health.
  
  
  OBJECTIVE
  To estimate the potential reduction in population mortality from implementation of the pay-for-performance contract in England.
  
  
  METHODS
  Cross-sectional and modelling study.
  
  
  METHODS
  Primary care in England.
  
  
  METHODS
  Twenty-five clinical quality indicators in the contract had controlled trial evidence of mortality benefit. This was combined with condition prevalence, and the differences in performance before and after contract implementation, to estimate the potential mortality reduction per indicator. Improvement was adjusted for pre-existing trends where data were available.
  
  
  RESULTS
  The 2004 contract potentially reduced mortality by 11 lives per 100 000 people (lower-upper estimates 7-16) over 1 year, as performance improved from baseline to the target for full incentive payment. If all eligible patients were treated, over and above the target, 56 (29-81) lives per 100 000 might have been saved. For the 2006 contract, mortality reduction was effectively zero, because new baseline performance for a typical practice had already exceeded the target performance for full payment.
  
  
  CONCLUSIONS
  The contract may have delivered substantial health gain, but potential health gain was limited by performance targets for full payment being set lower than typical baseline performance. Information on both baseline performance and population health gain should inform decisions about future selection of indicators for pay-for-performance schemes, and the level of performance at which full payment is triggered.
authors.affiliation: School of Medicine Health Policy and Practice, University of East Anglia, Norwich, UK. r.fleetcroft@uea.ac.uk
authors.forename: Robert
authors.initials: R
authors.lastname: Fleetcroft
authors.forename: Sheetal
authors.initials: S
authors.lastname: Parekh-Bhurke
authors.forename: Amanda
authors.initials: A
authors.lastname: Howe
authors.forename: Richard
authors.initials: R
authors.lastname: Cookson
authors.forename: Louise
authors.initials: L
authors.lastname: Swift
authors.forename: Nicholas
authors.initials: N
authors.lastname: Steel
mesh_terms: D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D058006:General Practice / Q000191:economics / Q000592:standards*; D006801:Humans; D009026:Mortality / Q000639:trends*; D010816:Physician Incentive Plans; D019984:Quality Indicators, Health Care; D019057:Quality-Adjusted Life Years; D012052:Reimbursement, Incentive; D018570:Risk Assessment