CAN PAYERS USE PRICES TO IMPROVE QUALITY? EVIDENCE FROM ENGLISH HOSPITALS
CAN PAYERS USE PRICES TO IMPROVE QUALITY? EVIDENCE FROM ENGLISH HOSPITALS
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DOI：
10.1002/hec.3121
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发表时间：
2016-01-01
期刊：
影响因子：
2.1
通讯作者：
Sutton, Matt
中科院分区：
文献类型：
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作者：
Allen, Thomas;Fichera, Eleonora;Sutton, Matt
在大多数以活动为基础的融资系统中，支付者根据医院报告成本的历史平均水平反应性地设定价格。如果医院对价格做出反应，支付者可能会主动设定价格，以影响特定治疗或临床实践的数量。我们评估了英国一项独特举措的效果，在这项举措中，医院在特定程序的同一天出院的价格提高了24%，而住院治疗的价格保持不变。使用2007年12月1日至2011年3月31日期间205 784名因激励程序入院的患者和838 369名因一系列非激励程序入院的患者的全国医院记录，我们考虑这种价格变化是否产生了预期的效果和/或产生了意想不到的影响。我们发现，价格变化导致日间费率增加了近6个百分点，计划日间费率增加了11个百分点。患者受益于计划中的腹腔镜手术期间较低比例的手术恢复为开腹手术，以及长期住院时间的减少。没有证据表明再入院和死亡率受到影响。结果表明，支付者可以主动定价，以激励医院提高质量。版权所有(C)2014 John Wiley&Sons，Ltd.
In most activity-based financing systems, payers set prices reactively based on historical averages of hospital reported costs. If hospitals respond to prices, payers might set prices proactively to affect the volume of particular treatments or clinical practice. We evaluate the effects of a unique initiative in England in which the price offered to hospitals for discharging patients on the same day as a particular procedure was increased by 24%, while the price for inpatient treatment remained unchanged. Using national hospital records for 205 784 patients admitted for the incentivised procedure and 838 369 patients admitted for a range of non-incentivised procedures between 1 December 2007 and 31 March 2011, we consider whether this price change had the intended effect and/or produced unintended effects. We find that the price change led to an almost six percentage point increase in the daycase rate and an 11 percentage point increase in the planned daycase rate. Patients benefited from a lower proportion of procedures reverted to open surgery during a planned laparoscopic procedure and from a reduction in long stays. There was no evidence that readmission and death rates were affected. The results suggest that payers can set prices proactively to incentivise hospitals to improve quality. Copyright (C) 2014 John Wiley & Sons, Ltd.