If you pay providers to do things, they will do them. For example, GP minor surgeries increased 41% after a 1990 contract change, with no reduction in hospital referrals. Payment by results also led to annual acute and elective admissions increases of 1.3-2.5%. However, things don't always work as intended. Case management programs for high-risk patients saw emergency admissions increase 16% in one study and 9% in another. It is easier to improve healthcare quality than reduce costs - only 18% of coordination intervention studies showed cost reductions. Investing in care homes resulted in a 35% reduction in hospital expenditures however, unintended consequences like supply-induced demand are possible when paying for services.