Does pay for performance affect socioeconomic inequalities in access? Evidence from hospital specialised care in England
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Pay for performance aims to improve quality and efficiency in the health sector but may widen inequalities. We investigate how pay for performance for specialised hospital care in England affected socioeconomic inequalities in access. We focus on two clinical areas: trauma care aimed at reducing delayed discharges from adult critical care; and internal medicine aimed at reducing in-hospital waiting time and length of stay for patients requiring urgent coronary bypass grafting. Both were part of the Prescribed Specialised Services Commissioning for Quality and Innovation. Using patient-level administrative data from Hospital Episodes Statistics in 2012/13–2016/17, we employ difference-in-difference models to estimate the impact of these schemes across socioeconomic status. Our treatment group comprises hospitals that adopted the scheme, and our control group the remaining eligible hospitals. For trauma care, we measure the impact of the scheme on discharge delays and the probability of an overnight discharge. For urgent coronary bypass, we measure pre-surgery inpatient waiting time, length of stay, 30-day and one-year mortality, and hospital-acquired infections. For trauma care we find the scheme widened inequalities by reducing delays that favoured more patients in the least income-deprived quintile (by 2.4 h or 30.4 % at the sample mean) than in the most income-deprived quintile (by 1.3 h). We find no effect or socioeconomic differences across outcomes for patients requiring an urgent coronary bypass.
Date Issued
2026-02-01
Date Acceptance
2025-05-28
Citation
Health Policy, 2026, 164
ISSN
0168-8510
Publisher
Elsevier BV
Journal / Book Title
Health Policy
Volume
164
Copyright Statement
© 2025 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/40664586
PII: S0168-8510(25)00121-6
Subjects
Efficiency
Hospitals
Pay for performance
Quality
Socioeconomic inequalities
Publication Status
Published
Coverage Spatial
Ireland
Article Number
105365
Date Publish Online
2025-06-23