Abstract
BackgroundPayment 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.MethodsAccredited 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.ResultsThe 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.ConclusionsNovel commissioning to incentivize achievement of specific clinical outcomes and attract new service providers can increase the effectiveness and supply of NHS stop smoking services.
Highlights
Smoking is a leading cause of premature mortality and morbidity in developed countries [1]
The number of four-week quits per 1,000 adult population increased per year on average by 9.6% in the intervention primary care trusts (PCTs) compared to a decrease of 1.1% in the control PCTs
These data were provided by National Health Service (NHS) West Midlands Healthcare Commissioning Services
Summary
Smoking is a leading cause of premature mortality and morbidity in developed countries [1]. Commissioners typically offered block contracts to providers meeting nationally defined criteria, which may use subcontractors to deliver services [3,4,11,12]. This approach to commissioning led to variation in the delivery of services and associated costs, and did not provide a strong incentive to maximise the number of quits achieved [2,12]. 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
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