The “Best Practice Tariff”-program (BPT) is one of many pay-for-performance models which have been introduced in the health system of the United Kingdom (UK). The first one was the "Quality and Outcome Framework" (QOF) followed by "Advancing Quality" (AQ), Commissioning for Quality and Innovation (CQUIN), "Non-Payment Policies" (NPP) until 2010, where the BPT has started. First, it was used in four indicators: cataract, gall bladder removal, stroke and fragility hip fracture. Now, the BPT includes 50 procedures in the UK. The payment of the service providers is based on the principles of the best treatment and therefore it does not depend on the average costs and can thus be higher or lower than the previously determined flat rate. The BPT can consequently be regarded as a punishment for hospitals that are not working compliant. The purpose of the BPT is to change treatments from inpatient cases to outpatient daycases, to reduce the number of appointments for patients and to increase the quality of the results. In the article by Allen et al. from 2016, the impact of the BPT on one of the four primary treatment cases, cholecystectomy, was investigated. Cholecystectomy is an operation in which the gallbladder is removed under general anesthesia, either laparoscopically or as an open surgery. Laparoscopic cholecystectomy is classified as an intervention in the UK, which can be performed as a daycase event. The aim of the BPT for cholecystectomy was to motivate the hospitals to carry out the procedure more frequently as a daycase event without losing quality. To investigate the effects of BPT, Allen et al. analyzed data from the Hospital Episodes Statistics from 1 December 2007 (before BPT) to 31 March 2011 (after introducing BPT). For this research, the cholecystectomy was compared with a control group consisting out of procedures from other medical fields (for example ear, nose, neck). After the evaluation Allen et al. came to the conclusion that a potential effect of the policy is visible. The concrete investigation results are discussed in Chapter 2.
Table of Contents
1. Summary of the Journal Article
2. Discussion of results
3. Discussion of the relevance of the problem identified
4. Is there anything to learn about for the German healthcare system?
5. References
Research Objectives and Core Topics
This paper examines the impact of the "Best Practice Tariff" (BPT) pay-for-performance model within the healthcare system of the United Kingdom, specifically focusing on its effectiveness in shifting inpatient cholecystectomy procedures to outpatient daycases. The central research objective is to analyze whether these financial incentives improve treatment quality and operational efficiency without causing negative outcomes, and to determine the potential transferability of such mechanisms to the German healthcare system.
- Mechanisms and history of pay-for-performance models in the UK (NHS).
- Empirical evaluation of the "Best Practice Tariff" on cholecystectomy cases.
- Analysis of patient outcomes including daycase rates, waiting times, and readmissions.
- Critical discussion of pay-for-performance as an alternative to fee-for-service systems.
- Feasibility study for implementing similar incentive structures in Germany.
Excerpt from the Book
1. Summary of the Journal Article
The “Best Practice Tariff”-program (BPT) is one of many pay-for-performance models which have been introduced in the health system of the United Kingdom (UK). The first one was the "Quality and Outcome Framework" (QOF) followed by "Advancing Quality" (AQ), Commissioning for Quality and Innovation (CQUIN), "Non-Payment Policies" (NPP) until 2010, where the BPT has started.1 First, it was used in four indicators: cataract, gall bladder removal, stroke and fragility hip fracture. Now, the BPT includes 50 procedures in the UK. The payment of the service providers is based on the principles of the best treatment and therefore it does not depend on the average costs and can thus be higher or lower than the previously determined flat rate. The BPT can consequently be regarded as a punishment for hospitals that are not working compliant.2 The purpose of the BPT is to change treatments from inpatient cases to outpatient daycases, to reduce the number of appointments for patients and to increase the quality of the results.3 In the article by Allen et al. from 2016, the impact of the BPT on one of the four primary treatment cases, cholecystectomy, was investigated. Cholecystectomy is an operation in which the gallbladder is removed under general anesthesia, either laparoscopically or as an open surgery. Laparoscopic cholecystectomy is classified as an intervention in the UK, which can be performed as a daycase event. The aim of the BPT for cholecystectomy was to motivate the hospitals to carry out the procedure more frequently as a daycase event without losing quality. To investigate the effects of BPT, Allen et al. analyzed data from the Hospital Episodes Statistics from 1 December 2007 (before BPT) to 31 March 2011 (after introducing BPT). For this research, the cholecystectomy was compared with a control group consisting out of procedures from other medical fields (for example ear, nose, neck). After the evaluation Allen et al. came to the conclusion that a potential effect of the policy is visible.4 The concrete investigation results are discussed in Chapter 2.
Summary of Chapters
1. Summary of the Journal Article: This chapter provides an overview of the Best Practice Tariff (BPT) program in the UK and outlines the methodology used by Allen et al. to study its impact on cholecystectomy procedures.
2. Discussion of results: This section presents the quantitative analysis of the BPT’s effects on hospital performance metrics, such as daycase rates and patient safety outcomes.
3. Discussion of the relevance of the problem identified: This chapter contextualizes BPT within broader pay-for-performance trends and discusses the shift from volume-based to quality-based healthcare incentives.
4. Is there anything to learn about for the German healthcare system?: This chapter evaluates the potential application of UK-style incentive structures within the German legal and structural healthcare framework.
5. References: A comprehensive list of academic sources and policy documents cited throughout the study.
Keywords
Best Practice Tariff, Pay-for-Performance, Healthcare, United Kingdom, Cholecystectomy, Daycase, Hospital Quality, Financial Incentives, Alternative Payment Models, Patient Outcomes, NHS, German Healthcare System, Efficiency, Medical Procedures, Healthcare Reform.
Frequently Asked Questions
What is the primary focus of this paper?
The paper focuses on the "Best Practice Tariff" (BPT) in the UK, analyzing its function as a financial incentive to improve the quality and efficiency of hospital procedures.
What are the core thematic fields covered?
The work covers health economics, pay-for-performance models, comparative health systems, and the management of hospital operations through policy incentives.
What is the central research question?
The study investigates whether the BPT successfully motivates hospitals to adopt more efficient practices, such as daycase surgeries, and whether these models can be adapted to the German healthcare system.
Which scientific methods were employed?
The paper relies on a literature review and a critical discussion of empirical findings from Allen et al. regarding the analysis of Hospital Episodes Statistics.
What is discussed in the main body?
The main body examines the specific effects of BPT on surgery rates, the broader theoretical relevance of quality-based payment, and the structural challenges of applying these lessons to Germany.
Which keywords best characterize this work?
Key terms include Pay-for-Performance, BPT, Cholecystectomy, NHS, Healthcare efficiency, and Healthcare reform.
How does the BPT act as a "punishment"?
The BPT is considered a financial penalty for hospitals that do not comply with "best practice" treatment standards, as the payment is no longer tied to flat-rate average costs.
Why is the "gatekeeper principle" a barrier to transferring UK policies to Germany?
In Germany, patients have free doctor choice, making it difficult to attribute specific treatment outcomes to a single physician compared to the UK's gatekeeper system.
- Arbeit zitieren
- Julian Torlutter (Autor:in), 2017, Kommentar zu "Can payers use prices to improve quality? Evidence from English hospitals", München, GRIN Verlag, https://www.grin.com/document/457988
