title: The impact of paying treatment providers for outcomes: difference-in-differences analysis of the 'payment by results for drugs recovery' pilot.
abstract: OBJECTIVE
  To estimate the effect on drug misuse treatment completion of a pilot scheme to pay service providers according to rates of recovery.
  
  
  METHODS
  A controlled, quasi-experimental (difference-in-differences) observational study using multi-level random effects logistic regression.
  
  
  METHODS
  Drug misuse treatment providers in all 149 commissioning areas in England in the financial years 2011-12 and 2012-13.
  
  
  METHODS
  Service users treated in England in 2011-12 and 2012-13.
  Linkage of provider payments to performance indicators in eight pilot commissioning areas in England compared with all 141 non-pilot commissioning areas in England.
  
  
  METHODS
  Recovery was measured by successful completion of treatment (free from drugs of dependence) and engagement with services was measured by rates of declining to continue with treatment.
  
  
  RESULTS
  Following the introduction of the pilot scheme, service users treated in pilot areas were 1.3 percentage points [odds ratio (OR) = 0.859; 95% confidence interval (CI) = 0.788, 0.937] less likely to complete treatment compared with those treated in comparison areas. Service users treated in pilot areas were 0.9 percentage points (OR = 2.934; 95% CI = 2.094, 4.113) more likely to decline to continue with treatment compared with those treated in comparison areas.
  
  
  CONCLUSIONS
  In the first year of the pilot 'Payment by Results for Drugs Recovery' scheme in England, linking payments to outcomes reduced the probability of completing drug misuse treatment and increased the proportion service users declining to continue with treatment.
authors.affiliation: Manchester Centre for Health Economics, University of Manchester, Manchester, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mason
authors.affiliation: Manchester Centre for Health Economics, University of Manchester, Manchester, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Sutton
authors.affiliation: Manchester Centre for Health Economics, University of Manchester, Manchester, UK.
authors.forename: William
authors.initials: W
authors.lastname: Whittaker
authors.affiliation: Institute for Criminal Policy Research, Birkbeck, University of London.
authors.forename: Tim
authors.initials: T
authors.lastname: McSweeney
authors.affiliation: National Drug Evidence Centre, University of Manchester, Manchester, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Millar
authors.affiliation: National Drug Evidence Centre, University of Manchester, Manchester, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Donmall
authors.affiliation: National Drug Evidence Centre, University of Manchester, Manchester, UK.
authors.forename: Andrew
authors.identifier: http://orcid.org/0000-0003-3545-4080
authors.initials: A
authors.lastname: Jones
authors.affiliation: National Drug Evidence Centre, University of Manchester, Manchester, UK.
authors.forename: Matthias
authors.initials: M
authors.lastname: Pierce
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D066264:Datasets as Topic; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D065228:Non-Randomized Controlled Trials as Topic; D010352:Patient Dropouts / Q000706:statistics & numerical data; D010865:Pilot Projects; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012052:Reimbursement, Incentive / Q000706:statistics & numerical data*; D016320:Substance Abuse Treatment Centers / Q000191:economics* / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Difference-in-differences; drugs policy; multi-level modelling; pay-for-performance; payment-by-results; performance measurement; policy analysis; random effects; unintended consequences