Taking care of the budget? Practice-level outcomesduring commissioning reforms in England

I investigate whether vesting budgets with doctors impacts treatment decisions and patients outcomes by exploiting the transitional phase of major recent health care reforms in England that passed budgets to consortia of General Practitioners (GPs). Applying difference-indifference techniques to balanced treatment and control groups, I find that practices becoming actively responsible for consortia budgets engaged in cost-saving prescribing and referral behaviour but that patients in these practices experienced a relative deterioration in the quality of their care. I discuss a number of explanations for these results, including that the reforms incentivised doctors to reduce quality in order to save cash or that they simply distracted those doctors most closely involved.