In a report on the policy's four-year roll-out period, the Commission finds that PbR has helped hospitals improve their financial management.
The Audit Commission says the NHS was providing care more efficiently through wider use of day treatments.
But it adds that PbR had 'at most contributed to these positive trends', which could also be credited to policies such as waiting time targets.
It finds that PCTs had proved less adept at redesigning inefficient services than acute trusts.
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