Paying hospitals a bonus for providing best patient care saves 900 lives in 18 months
Jeremy Laurance is a writer on health issues. He is former health editor of The Independent and the i and has covered the specialism for more than 20 years. He thinks the harm medicine does is under-appreciated, the harm it prevents over-rated, and that cycling works better than most drugs. He was named Specialist Journalist of the Year in the 2011 British Press Awards.
Thursday 08 November 2012
Almost 900 lives have been saved in 18 months among patients suffering from heart conditions and infections in one area of England by paying bonuses to hospitals that provided the best care to patients.
The scheme, run as a tournament among 24 hospitals in the north west region, involved paying hospitals sums worth tens of thousands of pounds to encourage them to follow best practice in three conditions – heart attack, heart failure and pneumonia.
The best 50 per cent received the bonuses which totalled almost £5 million over the 18 month period. Death rates in the hospitals involved in the scheme fell by 1.3 per cent compared to those elsewhere.
The north west region has a population of 6.8 million. If rolled out nationally the findings, published in the New England Journal of Medicine, imply almost 9,000 lives might be saved over the same period from improved care in the three conditions.
The scheme was based on one in the US. For heart attack patients , hospitals were required to provide an aspirin on arrival, prescribe a beta blocker when they were discharged and advise them on stopping smoking, among other measures.
For patients with pneumonia they were required to measure their blood oxygen level on arrival and start antibiotics.
Ruth McDonald, professor of health innovation at Nottingham University, said: “The scheme helped focus minds and saved lives – it is difficult to argue with that. But incentives can have unintended effects. They are a blunt instrument and must be handled with care.”
NHS hospitals across the country currently operate a pay-for-performance system based on withholding payments for the poorest performers rather than offering bonuses to the best.
The danger is that withdrawing funds from poor performers can make them even worse.
Professor McDonald said the NHS scheme began with Trusts forfeiting up to ½ per cent of their earnings from the NHS tariff but that had now risen to 2 ½ per cent and Sir David Nicholson, chief executive of the NHS, had said he wanted to raise it further.
“These schemes can seem very simple on paper, but in practice they can be very difficult to implement successfully.”
The system of paying bonuses had not worked in the US, though it had proved successful in the UK. Possible reasons were that hospital staff in the US had not met face to face to learn best practice from each other – the distances between them were too great and they had relied on seminars over the internet. Hospitals that did poorly had also dropped out, she said.
Matt Sutton, professor health economics at Manchester University, lead author of the study, said: “The combination of a competitive framework and the opportunity to get together to solve shared problems seems to be key to its success.”
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