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Main Title: The 2010 expansion of activity-based hospital payment in Israel: an evaluation of effects at the ward level
Author(s): Waitzberg, Ruth
Quentin, Wilm
Daniels, Elad
Perman, Vadim
Brammli-Greenberg, Shuli
Busse, Reinhard
Greenberg, Dan
Type: Article
Language Code: en
Abstract: Background: In 2010, Israel intensified its adoption of Procedure-Related Group (PRG) based hospital payments, a local version of DRG (Diagnosis-related group). PRGs were created for certain procedures by clinical fields such as urology, orthopedics, and ophthalmology. Non-procedural hospitalizations and other specific procedures continued to be paid for as per-diems (PD). Whether this payment reform affected inpatient activities, measured by the number of discharges and average length of stay (ALoS), is unclear. Methods: We analyzed inpatient data provided by the Ministry of Health from all 29 public hospitals in Israel. Our observations were hospital wards for the years 2008–2015, as proxies to clinical fields. We investigated the impact of this reform at the ward level using difference-in-differences analyses among procedural wards. Those for which PRG codes were created were treatment wards, other procedural wards served as controls. We further refined the analysis of effects on each ward separately. Results: Discharges increased more in the wards that were part of the control group than in the treatment wards as a group. However, a refined analysis of each treated ward separately reveals that discharges increased in some, but decreased in other wards. ALoS decreased more in treatment wards. Difference-in-differences results could not suggest causality between the PRG payment reform and changes in inpatient activity. Conclusions: Factors that may have hampered the effects of the reform are inadequate pricing of procedures, conflicting incentives created by other co-existing hospital-payment components, such as caps and retrospective subsidies, and the lack of resources to increase productivity. Payment reforms for health providers such as hospitals need to take into consideration the entire provider market, available resources, other – potentially conflicting – payment components, and the various parties involved and their interests.
Issue Date: 8-May-2019
Date Available: 22-Aug-2019
DDC Class: 610 Medizin und Gesundheit
Subject(s): activity-based payments
procedure-related group
diagnosis-related group
hospital financial incentives
health-policy reform
provider-payment reform
Sponsor/Funder: TU Berlin, Open-Access-Mittel - 2019
Journal Title: BMC health services research
Publisher: Springer Nature
Publisher Place: Heidelberg
Volume: 19
Issue: 1
Article Number: 292
Publisher DOI: 10.1186/s12913-019-4083-4
EISSN: 1472-6963
Appears in Collections:FG Management im Gesundheitswesen » Publications

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