System-Wide Impacts of Hospital Payment Reforms : Evidence from Central and Eastern Europe and Central Asia

Although there is broad agreement that the way that health care providers are paid affects their performance, the empirical literature on the impacts of provider payment reforms is surprisingly thin. During the 1990s and early 2000s, many European...

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Bibliographic Details
Main Authors:	Moreno-Serra, Rodrigo, Wagstaff, Adam
Format:	Policy Research Working Paper
Language:	English
Published:	2012
Subjects:	ACCESS TO HEALTH CARE ADMINISTRATIVE COSTS AGED AMBULATORY CARE BEDS BLOCK CONTRACTS BLOCK GRANTS BREAST CANCER CAPITA HEALTH SPENDING CAPITATION CATASTROPHIC HEALTH SPENDING CAUSES OF DEATH CHOICE OF PROVIDER CLINICAL PATHWAYS COSTS OF HOSPITALS DEATH RATE DEATH RATES DEATHS DIABETES DIAGNOSIS DIAGNOSTIC TESTS DIGESTIVE SYSTEM DISCHARGE PATIENTS DISEASES DISSEMINATION DRUGS ECONOMIES OF SCALE EXERCISES FEE SCHEDULE FEE-FOR-SERVICE FEE-FOR-SERVICE ARRANGEMENTS FEE-FOR-SERVICE METHODS GLOBAL BUDGETS HEALTH CARE HEALTH CARE MANAGEMENT HEALTH CARE PROVIDERS HEALTH CARE SECTOR HEALTH CARE SYSTEMS HEALTH ECONOMICS HEALTH EXPENDITURE HEALTH EXPENDITURES HEALTH FINANCING HEALTH FINANCING MECHANISM HEALTH FOR ALL HEALTH INSURANCE HEALTH INSURANCE COMPANIES HEALTH INSURANCE FUND HEALTH ORGANIZATION HEALTH OUTCOMES HEALTH PROFESSIONALS HEALTH SECTOR HEALTH SECTOR REFORM HEALTH SERVICE HEALTH STATUS HEALTH SYSTEM HEALTH SYSTEMS HEALTH SYSTEMS IN TRANSITION HOSPITAL HOSPITAL ADMISSION HOSPITAL ADMISSIONS HOSPITAL BEDS HOSPITAL CARE HOSPITAL COSTS HOSPITAL PATIENTS HOSPITAL REVENUES HOSPITAL SECTOR HOSPITAL SPENDING HOSPITALIZATION HOSPITALS HUMAN DEVELOPMENT IMPACT ON HEALTH INCOME INFORMAL PAYMENTS INPATIENT CARE INSURANCE ARRANGEMENTS INSURANCE COMPANIES INSURANCE SYSTEMS INSURERS MARGINAL COST MEDICAID MEDICAL CARE MEDICAL CONDITIONS MEDICAL DOCTORS MEDICAL PROCEDURES MEDICARE MINISTRIES OF HEALTH MINORITY MORTALITY MORTALITY REDUCTIONS NATIONAL HEALTH NATIONAL HEALTH SPENDING PATIENT PATIENTS PHYSICIANS POCKET PAYMENTS POLICY RESEARCH POLICY RESEARCH WORKING PAPER PREMATURE DEATH PRIMARY CARE PRIMARY CARE DOCTORS PRIMARY CARE SECTOR PRIMARY HEALTH CARE PRIVATE HOSPITALS PRIVATE SECTOR PRIVATE SPENDING PROVIDER PAYMENT PUBLIC HEALTH PUBLIC HEALTH EXPENDITURES PUBLIC SERVICES PUBLIC SPENDING PURCHASER-PROVIDER SPLIT PURCHASING POWER PURCHASING POWER PARITY QUALITY OF CARE QUALITY OF LIFE REIMBURSEMENT RATES REIMBURSEMENT SYSTEMS RESPECT SCREENING SOCIAL HEALTH INSURANCE URBAN POPULATION USE OF RESOURCES VACCINATIONS WAR WORLD HEALTH ORGANIZATION
Online Access:	http://www-wds.worldbank.org/external/default/main?menuPK=64187510&pagePK=64193027&piPK=64187937&theSitePK=523679&menuPK=64187510&searchMenuPK=64187283&siteName=WDS&entityID=000158349_20090715162549 http://hdl.handle.net/10986/4186

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Summary:	Although there is broad agreement that the way that health care providers are paid affects their performance, the empirical literature on the impacts of provider payment reforms is surprisingly thin. During the 1990s and early 2000s, many European and Central Asian countries shifted from paying hospitals through historical budgets to fee-for-service or patient-based-payment methods (mostly variants of diagnosis-related groups). Using panel data on 28 countries over the period 1990-2004, the authors of this study exploit the phased shift from historical budgets to explore aggregate impacts on hospital throughput, national health spending, and mortality from causes amenable to medical care. They use a regression version of difference-in-differences and two variants that relax the difference-in-differences parallel trends assumption. The results show that fee-for-service and patient-based-payment methods both increased national health spending, including private (out-of-pocket) spending. However, they had different effects on inpatient admissions (fee-for-service increased them; patient-based-payment had no effect), and average length of stay (fee-for-service had no effect; patient-based-payment reduced it). Of the two methods, only patient-based-payment appears to have had any beneficial effect on "amenable mortality," but there were significant impacts for only a couple of causes of death, and not in all model specifications.

System-Wide Impacts of Hospital Payment Reforms : Evidence from Central and Eastern Europe and Central Asia

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