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Funding without strings: an investigation into the impact of the introduction of payment by results into the National Health Service on aligning clinical and managerial incentives.

Willis, Andrew (2015) Funding without strings: an investigation into the impact of the introduction of payment by results into the National Health Service on aligning clinical and managerial incentives. PhD thesis, London School of Economics and Political Science (LSE).

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Abstract

This research investigates whether the introduction of Payment By Results (PbR) into the National Health Service aligned clinical and managerial incentives and improved output, quality, quantity and productivity. The methodology applies three data collection techniques; in-depth interviews; documentary data; and numerical data for each of four foundation trust (FT) case studies. The results indicate that the case studies had not produced consistent and sustained improvements in productivity and did not appear particularly engaged with productivity improvement, or cost control or in the relationship between these factors and tariff under PbR. Boards of directors did not appear to focus on productivity; and the use of service line reporting, to allow clinicians and managers of hospitals to drive productivity improvement, was not widely available at board or clinical level. The results also demonstrated the dominance of Monitor, the FT regulator, in influencing the agenda of FT boards. It suggests that, without central direction and/or external pressure, FTs will not focus on productivity and quality issues. The policy significance of these results are that (a) with the lack of alignment of clinical and managerial incentives, it is unlikely that FTs will be able to produce a sophisticated and targeted review of clinical care pathways to target productivity improvement at areas where there is real opportunity for efficiency improvement; and (b) if, as the research results suggest, NHS management, and the organisations they lead, respond more effectively to central direction and control then, as the NHS enters one of the most financially challenged periods of its history, alternative policy options to the development of quasi markets need to be considered. The research explores several of these options, including: the roll-back of the FT movement, management franchising, creating conditions for increased pressure on hospital performance, a more radical introduction of competition, and options for the use of social enterprises.

Item Type: Thesis (PhD)
Additional Information: © 2015 Andrew Willis
Library of Congress subject classification: H Social Sciences > HV Social pathology. Social and public welfare. Criminology
Sets: Departments > Social Policy
Supervisor: Le Grand, Julian
URI: http://etheses.lse.ac.uk/id/eprint/3114

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