The 2010 expansion of activity-based hospital payment in Israel: an evaluation of effects at the ward level

dc.contributor.authorWaitzberg, Ruth
dc.contributor.authorQuentin, Wilm
dc.contributor.authorDaniels, Elad
dc.contributor.authorPerman, Vadim
dc.contributor.authorBrammli-Greenberg, Shuli
dc.contributor.authorBusse, Reinhard
dc.contributor.authorGreenberg, Dan
dc.date.accessioned2019-08-22T12:15:49Z
dc.date.available2019-08-22T12:15:49Z
dc.date.issued2019-05-08
dc.description.abstractBackground: 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.en
dc.description.sponsorshipTU Berlin, Open-Access-Mittel - 2019en
dc.identifier.eissn1472-6963
dc.identifier.urihttps://depositonce.tu-berlin.de/handle/11303/9849
dc.identifier.urihttp://dx.doi.org/10.14279/depositonce-8861
dc.language.isoenen
dc.relation.ispartof10.14279/depositonce-12507en
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/en
dc.subject.ddc610 Medizin und Gesundheitde
dc.subject.otheractivity-based paymentsen
dc.subject.otherprocedure-related groupen
dc.subject.otherdiagnosis-related groupen
dc.subject.otherhospital financial incentivesen
dc.subject.otherhealth-policy reformen
dc.subject.otherprovider-payment reformen
dc.subject.otherPRGen
dc.subject.otherDRGen
dc.titleThe 2010 expansion of activity-based hospital payment in Israel: an evaluation of effects at the ward levelen
dc.typeArticleen
dc.type.versionpublishedVersionen
dcterms.bibliographicCitation.articlenumber292en
dcterms.bibliographicCitation.doi10.1186/s12913-019-4083-4en
dcterms.bibliographicCitation.issue1en
dcterms.bibliographicCitation.journaltitleBMC health services researchen
dcterms.bibliographicCitation.originalpublishernameSpringer Natureen
dcterms.bibliographicCitation.originalpublisherplaceHeidelbergen
dcterms.bibliographicCitation.volume19en
tub.accessrights.dnbfreeen
tub.affiliationFak. 7 Wirtschaft und Management::Inst. Technologie und Management (ITM)::FG Management im Gesundheitswesende
tub.affiliation.facultyFak. 7 Wirtschaft und Managementde
tub.affiliation.groupFG Management im Gesundheitswesende
tub.affiliation.instituteInst. Technologie und Management (ITM)de
tub.publisher.universityorinstitutionTechnische Universität Berlinen

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