A paper by Sutton, Elder Guthrie and Watt (2010) describes the UK’s National Health Service’s (NHS) adoption of the Quality and Outcomes Framework (QOF) in April 2004. In general, P4P programs can have positive or negative spillovers. An example of a positive spillover would be the adoption of EMR to comply with certain P4P initiatives, but which also improves productivity in other areas. A negative spillover would occur if physicians focus on getting the P4P bonuses, but decrease effort in unmeasured areas which could be more important to the patient’s health.
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