Surgery doesn't pay-but does it matter? Payment by Results in the UK National Health Service

Studies show that the main system of hospital reimbursement in the UK National Health Service (NHS), Payment by Results, does not meet the actual costs of surgical procedures, which contributes to hospitals' financial deficit. The resulting local cost cutting measures in turn constrain capacity and quality. This article examines some limitations in analysing Payment by Results in isolation. Although funding might not meet the costs of surgical services, the proportion of overall costs influenced by clinicians is small, because the bulk of costs are fixed. While on one level this seems frustrating, it can also be viewed as liberating; freeing clinicians from the futility of adjusting clinical practice to attempt to balance the books. They should instead correctly focus on quality of care and patient outcomes.