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This paper examines the synthetic control method in contrast to commonly used difference‐in‐differences (DiD) estimation, in the context of a re‐evaluation of a pay‐for‐performance (P4P) initiative, the Advancing Quality scheme. The synthetic control method aims to estimate treatment effects by constructing a weighted combination of control units, which represents what the treated group would have experienced in the absence of receiving the treatment. While DiD estimation assumes that the effects of unobserved confounders are constant over time, the synthetic control method allows for these effects to change over time, by re‐weighting the control group so that it has similar pre‐intervention characteristics to the treated group.We extend the synthetic control approach to a setting of evaluation of a health policy where there are multiple treated units. We re‐analyse a recent study evaluating the effects of a hospital P4P scheme on risk‐adjusted hospital mortality. In contrast to the original DiD analysis, the synthetic control method reports that, for the incentivised conditions, the P4P scheme did not significantly reduce mortality and that there is a statistically significant increase in mortality for non‐incentivised conditions. This result was robust to alternative specifications of the synthetic control method. © 2015 The Authors. Health Economics published by John Wiley & Sons Ltd.

Background The population of older adults (ie, those aged ≥55 years) in England is becoming increasingly ethnically diverse. Previous reports indicate that ethnic inequalities in health exist among older adults, but information is limited by the paucity of data from small minority ethnic groups. This study aimed to analyse inequalities in healthrelated quality of life (HRQoL) and five determinants of health in older adults across all ethnic groups in England. MethodsIn this cross-sectional study, we analysed data from five waves (July 1, 2014, to April 7, 2017) of the nationally representative English General Practice Patient Survey (GPPS). Study participants were adults aged 55 years or older who were registered with general practices in England. We used regression models (age-adjusted and stratified by gender) to estimate the association between ethnicity and HRQoL, measured by use of the EQ-5D-5L index and its domains (mobility, self-care, usual activities, pain or discomfort, and anxiety or depression). We also estimated associations between ethnicity and five determinants of health (presence of long-term conditions or multimorbidity, experience of primary care, degree of support from local services, patient self-confidence in managing own health, and degree of area-level social deprivation). We examined robustness to differential handling of missing data, alternative EQ-5D-5L value sets, and differences in area-level social deprivation. FindingsThere were 1 416 793 GPPS respondents aged 55 years and older. 1 394 361 (98•4%) respondents had complete data on ethnicity and gender and were included in our analysis. Of these, 152 710 (11•0%) self-identified as belonging to minority ethnic groups. HRQoL was worse for men or women, or both, in 15 (88•2%) of 17 minority ethnic groups than the White British ethnic group. In both men and women, inequalities were widest for Gypsy or Irish Traveller (linear regression coefficient -0•192 [95% CI -0•318 to -0•066] in men; -0•264 [-0•354 to -0•173] in women), Bangladeshi (-0•111 [-0•136 to -0•087] in men; -0•209 [-0•235 to -0•184] in women), Pakistani (-0•084 [-0•096 to -0•073] in men; -0•206 [-0•219 to -0•193] in women), and Arab (-0•061 [-0•086 to -0•035] in men; -0•145 [-0•180 to -0•110] in women) ethnic groups, with magnitudes generally greater for women than men. Differentials tended to be widest for the self-care EQ-5D-5L domain. Ethnic inequalities in HRQoL were accompanied by increased prevalence of long-term conditions or multimorbidity, poor experiences of primary care, insufficient support from local services, low patient self-confidence in managing their own health, and high area-level social deprivation, compared with the White British group.Interpretation We found evidence of wide ethnic inequalities in HRQoL and five determinants of health for older adults in England. Outcomes varied between minority ethnic groups, highlighting heterogeneity in the direction and magnitude of associations. We recommend further research to understand the drivers of inequalitie...