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Governance, commissioning and public health$
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Linda Marks

Print publication date: 2014

Print ISBN-13: 9781447304944

Published to Policy Press Scholarship Online: January 2015

DOI: 10.1332/policypress/9781447304944.001.0001

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Levers for change (2): incentives

Levers for change (2): incentives

(p.123) CHAPTER FIVE Levers for change (2): incentives
Governance, commissioning and public health

Linda Marks

Policy Press

This chapter assesses the impact on performance of financial and other incentives, locating debates in a theoretical economic framework, and considers characteristics of 'incentive contracts'. At the time of the study, incentives for increased activity, performance, partnership working and quality improvement were in place. The chapter reviews their impact and how commissioners exploited reward schemes and contractual flexibilities for promoting health and wellbeing. It discusses incentives for quality improvement in primary care, rewards for GP involvement in commissioning and incentives for delivering specific preventive services. Benefits and drawbacks of incentives are discussed, drawing on study data. Incentives were often piecemeal and uncoordinated and a transactional approach risked undermining local engagement. However, they encouraged the provision of evidence-based preventive services. The chapter demonstrates the importance of considering perverse incentives, potential effects across a whole system, and factors involved in developing incentive contracts.

Keywords:   incentives, incentive contracts, preventive services, contractual flexibilities, performance

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