Uncertainty about the effort–performance relationship in threshold-based payment schemes

Publication date: November 2018Source: Journal of Health Economics, Volume 62Author(s): Anne Sophie Oxholm, Søren Rud Kristensen, Matt SuttonAbstractIncentive schemes often feature a threshold beyond which providers receive no additional payment for performance. We investigate whether providers’ uncertainty about the relationship between effort and measured performance leads to financially unrewarded performance in such schemes. Using data from the British Quality and Outcomes Framework, we proxy general practitioners’ uncertainty about the effort–performance relationship by their experience with the scheme and their span of control. We find evidence that providers respond to uncertainty by exerting financially unrewarded performance, suggesting that uncertainty may be a mechanism by which payers can extract unrewarded performance.
Source: Journal of Health Economics - Category: Health Management Source Type: research