Ada Ma

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

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.

Determinants of General Practitioners' Wages in England

We analyse the determinants of annual net income and wages (net income/hours) of general practitioners (GPs) using data for 2271 GPs in England recorded during Autumn 2008. The average GP had an annual net income of £97,500 and worked 43 h per week. The mean wage was £51 per h. Net income and wages depended on gender, experience, list size, partnership size, whether or not the GP worked in a dispensing practice, whether they were salaried of self-employed, whether they worked in a practice with a nationally or locally negotiated contract, and the characteristics of the local population (proportion from ethnic minorities, rurality, and income deprivation). The findings have implications for pay discrimination by GP gender and ethnicity, GP preferences for partnership size, incentives for competition for patients, and compensating differentials for local population characteristics. They also shed light on the attractiveness to GPs in England of locally negotiated (personal medical services) versus nationally negotiated (general medical services) contracts.

The Pattern and Evolution of Geographical Wage Differentials in the Public and Private Sectors in Great Britain

Government policy on the nature of wage bargaining in the public sector can have important implications for the provision of public services. Using the New Earnings Survey, the Labour Force Survey and the British Household Panel Survey, we examine the size and evolution of public–private sector wage differentials across geographical areas within the UK and over time. Public sector bargaining structures have led to historically high wage premia, although these premia are declining over time. In high‐cost low‐amenity areas, such as the south‐east of England, the public sector underpays relative to the private sector, therefore creating problems in recruitment to and provision of public services. Public sector labour markets are around 40 per cent as responsive to area differences in amenities and costs as are private sector labour markets. Differences in the degree of spatial variation between sectors are likely to remain, leading to persistent problems for the delivery of public services in some parts of the UK. Reform of public sector pay structures is likely to be costly, and so other non‐pay policies need to be considered to increase the attractiveness of public sector jobs.

Devolved government and public sector pay reform: Considerations of equity and efficiency

Elliott R. F., Bell D., Scott A., Ma A. and Roberts E. (2005) Devolved government and public sector pay reform: considerations of equity and efficiency, Regional Studies 39 , 519–539. Public sector pay is of critical concern to the governments in Westminster and Edinburgh. It accounts for the major part of these governments current expenditures and is a crucial determinant of the quality and range of the services they provide. The paper details the current arrangements for setting public sector pay. It is shown that these mechanisms are, for the most part, UK wide and that they result in national rates of pay that reveal little sensitivity to specific labour market conditions in Scotland. In consequence, in Scotland, public sector workers toward the lower end of the distribution of pay are now significantly better paid than their private sector counterparts while those at the upper end are now paid about the same. The paper uses data from the Labour Force Survey for 1996–2002 to establish these results. It uses these same data to forecast the changes in pay inequality in the Scottish public sector that would result from a reform of public sector pay setting institutions that aimed to bring rates of pay in the public sector into line with those in the private sector in Scotland.