Doctor Behaviour under a Pay for Performance Contract: Treating, Cheating and Case Finding?

Hugh Gravelle, Matt Sutton, Ada Hoi Yan Ma

Research output: Contribution to journalArticlepeer-review

85 Citations (Scopus)


The UK National Health Service introduced a pay for performance scheme for primary care providers in 2004/5. The scheme rewarded providers for the proportion of eligible patients who received appropriate treatment. Eligible patients were those who had been reported by the provider as having the relevant disease minus those they exception reported as not suitable for treatment. Using rich provider level data, we find that differences in reported disease rates between providers, and differences in exception rates both between and within providers, suggest gaming. Faced with ratio performance indicators, providers acted on denominators as well as numerators.

Original languageEnglish
Pages (from-to)F129-F156
Number of pages28
JournalEconomic Journal
Issue number542
Early online date20 Jan 2010
Publication statusPublished - Feb 2010


  • quality-of-care
  • outcomes framework
  • United-Kingdom
  • health-care
  • financial incentives
  • for-performance
  • England
  • physicians
  • system

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