Market failure

摘要

Payment by results was intended to enable commissioners and providers to focus and compete on quality ratherthan costs. Farrarand colleagues showed that quality (as measured) did not change.1 Perhaps the healthcare market cannot be used to improve quality, payment by results is the wrong tool to improve quality, or the assessment of quality was inadequate, or all three.Farrar and colleagues showed a small improvement in productivity. This may be more than offset by the additional administrative costs for both commissioners and providers. They found no change in case mix. Indeed, the increased numberof day case procedures may reflect, overall, that healthier patients receive treatment. In sexual health, for example, payment by results rewards providing minimal services forthe worried well while penalising targeting those who have most to gain from using the services-the most expensive patients.