title: Effect of pay-for-outcomes and encouraging new providers on national health service smoking cessation services in England: a cluster controlled study.
abstract: BACKGROUND
  Payment incentives are known to influence healthcare but little is known about the impact of paying directly for achieved outcomes. In England, novel purchasing (commissioning) of National Health Service (NHS) stop smoking services, which paid providers for quits achieved whilst encouraging new market entrants, was implemented in eight localities (primary care trusts (PCTs)) in April 2010. This study examines the impact of the novel commissioning on these services.
  
  
  METHODS
  Accredited providers were paid standard tariffs for each smoker who was supported to quit for four and 12 weeks. A cluster-controlled study design was used with the eight intervention PCTs (representing 2,138,947 adult population) matched with a control group of all other (n=64) PCTs with similar demographics which did not implement the novel commissioning arrangements. The primary outcome measure was changes in quits at four weeks between April 2009 and March 2013. A secondary outcome measure was the number of new market entrants within the group of the largest two providers at PCT-level.
  
  
  RESULTS
  The number of four-week quits per 1,000 adult population increased per year on average by 9.6% in the intervention PCTs compared to a decrease of 1.1% in the control PCTs (incident rate ratio 1∙108, p<0∙001, 95% CI 1∙059 to 1∙160). Eighty-five providers held 'any qualified provider' contracts for stop smoking services across the eight intervention PCTs in 2011/12, and 84% of the four-week quits were accounted for by the largest two providers at PCT-level. Three of these 10 providers were new market entrants. To the extent that the intervention incentivized providers to overstate quits in order to increase income, caution is appropriate when considering the findings.
  
  
  CONCLUSIONS
  Novel commissioning to incentivize achievement of specific clinical outcomes and attract new service providers can increase the effectiveness and supply of NHS stop smoking services.
authors: Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham B15 2TT, UK.
authors: Hugh
authors: H
authors: McLeod
authors: Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham B15 2TT, UK.
authors: Deirdre
authors: D
authors: Blissett
authors: NHS Midlands and Lancashire Commissioning Support Unit, Kingston House, High Street, West Bromwich B70 9LD, UK.
authors: Steven
authors: S
authors: Wyatt
authors: School of Health Studies, University of Bradford, Richmond Road, Bradford BD7 1DP, UK.
authors: Mohammed A
authors: MA
authors: Mohammed
mesh_terms: D000328:Adult; D016000:Cluster Analysis; D003362:Cost-Benefit Analysis; D004739:England; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data; D011634:Public Health / Q000191:economics* / Q000379:methods; D012907:Smoking / Q000191:economics*; D016540:Smoking Cessation / Q000191:economics* / Q000379:methods; D000074606:Smoking Prevention; D012923:Social Class; D013222:State Medicine / Q000191:economics*; D013997:Time Factors