Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-15T07:59:19.711Z Has data issue: false hasContentIssue false
  • English
  • Français

Efficiency improvements of public hospitals under a capitation payment scheme

Published online by Cambridge University Press:  24 January 2013

Javier García-Lacalle  and
Emilio Martín
Javier García-Lacalle*
Affiliation:
Department of Accounting and Finance, Faculty of Economics and Business Administration, University of Zaragoza, Zaragoza, Spain
Emilio Martín
Affiliation:
Department of Accounting and Finance, Faculty of Economics and Business Administration, University of Zaragoza, Zaragoza, Spain
*
*Correspondence to: Javier García-Lacalle, Department of Accounting and Finance, Faculty of Economics and Business Administration, University of Zaragoza, Gran Vía 2, 50005 Zaragoza, Spain. E-mail: jlacalle@unizar.es
Get access Rights & Permissions [Opens in a new window]

Abstract

In a context of cost containment and demands for better quality in public health care, payment systems are used as an instrument to promote efficiency improvements in service providers. Andalusia has adopted an original type of risk-adjusted capitation payment mechanism to reimburse public hospitals. This paper presents the main characteristics of the reimbursement mechanism of the Andalusian Health Service highlighting some differences with the mechanisms adopted in other parts of Europe. The paper also explores the evolution of the efficiency and quality of the hospitals after its implementation using the Malmquist index. Results indicate that hospitals have slightly improved their efficiency, particularly urban hospitals, and these improvements are not significantly related to a negative evolution of quality. However, it is not possible to assert to what extent, improvements are the consequence of the new payment system. The organisation of the Servicio Andaluz de Salud and the limited competition between hospitals reduce the effectiveness of the reform.

Type
Articles
Information
Health Economics, Policy and Law , Volume 8 , Issue 3 , July 2013 , pp. 335 - 364
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aas, I. H. M. (1995), ‘Incentives and financing methods’, Health Policy, 34: 205–220.Google Scholar
Allen, P. (2009), ‘Payment by results in the English NHS: the continuing challenges’, Public Money & Management, 29(3): 161–166.Google Scholar
Ankjær-Jensen, A., Roslingand, P.Bilde, L. (2006), ‘Variable prospective financing in the Danish hospital sector and the development of a Danish case-mix system’, Health Care Management Science, 9: 259–268.Google Scholar
Ashton, C. M., del Junco, D. J.Mansyur, C. (1997), ‘The association between the quality of in-patient care and early readmission: a meta-analysis of the evidence’, Medical Care, 35: 1044–1059.Google Scholar
Athanassopoulos, A.Gounaris, C. (2001), ‘Assessing the technical and allocative efficiency of hospital operations in Greece and its resource allocation implications’, European Journal of Operational Research, 133: 416–431.Google Scholar
Bellanger, M.Mossé, P. (2005), ‘The search for the Holy Grail: combining decentralised planning and contracting mechanisms in the French health care system’, Health Economics, 14: 119–132.Google Scholar
Bellanger, M.Tardif, L. (2006), ‘Accounting and reimbursement schemes for inpatient care in France’, Health Care Management Science, 9: 295–305.Google Scholar
Botten, G., Grepperud, S.Nerland, S.M. (2004), ‘Trading patients. Lessons from Scandinavia’, Health Policy, 69: 317–327.CrossRefGoogle ScholarPubMed
Boyle, S. (2011), ‘United Kingdom (England): Health System Review’, in A. Maresso and E. Mossialos (eds), Health Systems in Transition, vol. 13, no. 1. Copenhagen: European Observatory on Health Systems and Policies Series, 1–486.Google Scholar
Carey, K.Burgess, J. F. (1999), ‘On measuring the hospital cost/quality trade-off’, Health Economics, 8: 509–520.Google Scholar
Charnes, A., Cooper, W.Rhodes, E. (1978), ‘Measuring the efficiency of decision making units’, European Journal of Operational Research, 2: 429–444.Google Scholar
Cheng, S., Yang, M.Chiang, T. (2003), ‘Patient satisfaction with and recommendation of a hospital: effects of interpersonal and technical aspects of hospital care’, International Journal of Quality in Health Care, 15: 345–355.Google Scholar
Chevreul, K., Durand-Zaleski, I., Bahrami, S., Hernández-Quevedo, C.Mladovsky, P. (2010), ‘France: Health System Review’, in C. Hernández-Quevedo and P. Mladovsky (eds), Health Systems in Transition, vol. 12, no. 6. Copenhagen: European Observatory on Health Systems and Policies Series, 1–326..Google Scholar
Clarke, A. (2004), ‘Readmission to hospital: a measure of quality or outcome?’, Quality and Safety in Health Care, 13: 10–11.Google Scholar
Cooper, W., Seiford, L.Tone, K. (2000), Data Envelopment Analysis: A Comprehensive Text with Models, Applications, References and DEA-Solver Software, London: Kluwer Academic Publishers.Google Scholar
Cylus, J.Irwin, R. (2010), ‘The challenges of hospital payment systems’, The Health Policy Bulletin of the European Observatory on Health Systems and Policies, 12(3): 1–4.Google Scholar
Department of Health (DoH) (2002), Reforming NHS financial flows: introducing payment by results, London: Department of Health.Google Scholar
Dismuke, C.Sena, L. (2001), ‘Is there a trade-off between quality and productivity? The case of diagnostic technologies in Portugal’, Annals of Operation Research, 107: 101–116.Google Scholar
Epstein, D.Mason, A. (2006), ‘Costs and prices for inpatient care in England: mirror twins or distant cousins?’, Health Care Management Science, 9: 233–242.CrossRefGoogle ScholarPubMed
Färe, R., Grosskopf, S., Norris, M.Zhang, Z. (1994), ‘Productivity growth, technical progress and efficiency changes in industrialized countries’, American Economic Review, 84: 66–83.Google Scholar
Farrar, S., Yi, D., Sutton, M., Clakley, M., Sussex, J.Scott, A. (2009), ‘Has payment by results affected the way in which English hospitals provide care? Difference-in-differences analysis’, British Medical Journal, 339 :b3047, doi:10.1136/bmj.b3047.Google Scholar
Gaal, P., Stefka, N.Nagy, J. (2006), ‘Cost accounting methodologies in price setting of acute inpatient services in Hungary’, Health Care Management Science, 9: 243–250.Google Scholar
García-Lacalle, J.Martin, E. (2010), ‘Rural vs urban hospital performance in a ‘competitive’ public health service’, Social Science & Medicine, 71: 1131–1140.Google Scholar
García-Lacalle, J., Martin, E. (2011), ‘Financing reforms and hospital performance: effect of changing the reimbursement method on hospital productivity’, 34th European Accounting Association Congress, Rome, April 2011.Google Scholar
Gavira, L.Carmona, G. (2012), Resultados y calidad del sistema sanitario público de Andalucía, Sevilla: Junta de Andalucía, Edición 2012.Google Scholar
Gruca, T. S.Nath, D. (2001), ‘The technical efficiency of hospitals under a single payer system: the case of Ontario community hospitals’, Health Care Management Science, 4: 91–101.Google Scholar
Häkkinen, U. (2010), ‘Financing of hospital care in Finland’, The health policy bulletin of the European Observatory on Health Systems and Policies, 12(3): 10–13.Google Scholar
Ho, V.Hamilton, B. H. (2000), ‘Hospital mergers and acquisitions: does market consolidation harm patients?’, Journal of Health Economics, 19: 767–791.Google Scholar
Hollingsworth, B. (2003), ‘Non-parametric and parametric applications measuring the efficiency in health care’, Health Care Management Science, 6: 203–219.Google Scholar
Hollingsworth, B. (2008), ‘The measurement of efficiency and productivity of health care delivery’, Health Economics, 17(10): 1107–1128.Google Scholar
Hollingsworth, B., Dawson, P. J.Maniadakis, N. (1999), ‘Efficiency measurement of health care: a review of non-parametric methods and applications’, Health Care Management Science, 2: 161–172.Google Scholar
Jegers, M., Kesteloot, K., De Graeve, D.Gilles, W. (2002), ‘A typology for provider payment systems in health care’, Health Policy, 60: 255–273.Google Scholar
Jha, A. K., Orav, E. J., Li, Z.Epstein, A. M. (2007), ‘Market watch: the inverse relationship between mortality rates and performance in the hospital quality alliance measures’, Health Affairs, 26(4): 1104–1110.CrossRefGoogle Scholar
Johnes, G.Johnes, J. (1993), ‘Measuring the research performance of UK economics departments: an application of data envelopment analysis’, Oxford Economic Papers, 4(2): 332–347.Google Scholar
Kaboli, P. J.Barnett, M. J. (2004), ‘Associations with reduced length of stay and costs on an academic hospitalist service’, American Journal of Managed Care, 10: 561–568.Google Scholar
Kesteloot, K.Voet, N. (1998), ‘Incentives for cooperation in quality improvement among hospitals – the impact of the reimbursement system’, Journal of health economics, 17: 701–728.Google Scholar
Kim, T. H. (2010), ‘Factors associated with financial distress of nonprofit hospitals’, Health Care Management, 29(1): 52–62.Google Scholar
Kutzin, J. (2001), ‘A descriptive framework for country-level analysis of health care financing arrangements’, Health Policy, 56(3): 171–203.Google Scholar
Langenbrunner, J. C.Wiley, M. M. (2002), ‘Hospital Payment Mechanisms: Theory and Practice in Transition Countries’, in M. McKee and J. Healy (eds), Hospitals in a Changing Europe, England: European Observatory on Health Systems and Policies Series. Open University Press, 150–176.Google Scholar
Leonard, K., Rauner, M., Schaffhauser-Linzatti, M. S.Yap, R. (2003), ‘The effect of funding policy on day of week admissions and discharges in hospitals: the cases of Austria and Canada’, Health Policy, 63: 239–257.Google Scholar
Linna, M. (2000), ‘Health care financing reform and the productivity change in Finnish hospitals’, Journal of Health Care Finance, 26(3): 83–100.Google Scholar
Mckay, N.Deily, M. (2008), ‘Cost inefficiency and hospital health outcomes’, Health Economics, 17: 833–848.Google Scholar
Nayar, P.Ozcan, Y. (2008), ‘Data envelopment analysis comparison of hospital efficiency and quality’, Journal of Medical Systems, 32: 193–199.Google Scholar
Northcott, D.Llewellyn, S. (2003), ‘The ladder of success in healthcare: the UK national reference costing index’, Management Accounting Research, 14: 51–66.Google Scholar
OECD (2008), OECD Health Data, June.Google Scholar
OECD (2010), OECD Health Data 2010, June.Google Scholar
OECD (2011), OECD Health Data, June.Google Scholar
O'Neill, L., Rauner, M., Heidenberger, K.Kraus, M. (2008), ‘A cross-national comparison and taxonomy of DEA-based hospital efficiency studies’, Socio-Economic Planning Sciences, 42(3): 158–189.Google Scholar
Peacock, S.Segal, L. (2000), ‘Capitation funding in Australia: imperatives and impediments’, Health Care Management Science, 3(2): 77–88.Google Scholar
Peñaloza, M.-C., Hardie, M., Wild, R., Mills, K. (2010), UK Centre for the Measurement of Government Activity – Public Service Output, Inputs and Productivity: Healthcare, Newport: Office For National Statistics, http://www.statistics.gov.uk/articles/nojournal/healthcare-productivity-2010.pdf.Google Scholar
Pilyavsky, A.Staat, M. (2008), ‘Efficiency and productivity change in Ukrainian health care’, Journal of Productivity Analysis, 29: 143–154.Google Scholar
Pina, V.Torres, L. (1996), ‘Methodological aspects in efficiency evaluation of public hospitals’, Financial Accountability and Management, 12(1): 21–36.Google Scholar
Prior, D. (2006), ‘Efficiency and total quality management in health care organizations: a dynamic frontier approach’, Annals of Operations Research, 145: 281–299.Google Scholar
Propper, C., Wilson, D.Burgess, S. (2006), ‘Extending choice in English healthcare: the implications of the economic evidence’, Journal of Social Policy, 35(4): 537–557.Google Scholar
Quentin, W., Geissler, A., Scheller-Kreinsen, D.Busse, R. (2010), ‘DRG- type hospital payment in Germany: the G-DRG system’, The Health Policy Bulletin of the European Observatory on Health Systems and Policies, 12(3): 4–7.Google Scholar
SAS (2004), Información al ciudadano sobre actividad y calidad de los hospitales, Sevilla: Servicio Andaluz de Salud.Google Scholar
SAS (2006), Annual Report of the Andalusian Health Service, 2006 (in Spanish), Sevilla: Servicio Andaluz de Salud.Google Scholar
SAS (2007), Modelo de financiación capitativa de Hospitales, Distritos de Atención Primaria y Áreas de Gestión Sanitaria, Sevilla: Servicio Andaluz de Salud.Google Scholar
Scheller-Kreinsen, D., Geissler, A.Busse, R. (2009), ‘The ABC of DRGs’, Euro Observer, 11: 1–5.Google Scholar
Shmueli, A., Intrator, O.Israeli, A. (2002), ‘The effects of introducing prospective payments to general hospitals on length of stay, quality of care, and hospitals’ income: the early experience of Israel’, Social Science & Medicine, 55: 981–989.Google Scholar
Smith, P. C., Preker, A. S., Ligth, D. W.Richard, S. (2005), ‘Role of Markets and Competition’, in J. Figueras, R. Robinson and E. Jakubowski (eds), Purchasing to Improve Health Systems Performance, England: European Observatory on Health Systems and Policies Series. Open University Press, 102–121.Google Scholar
Steinbusch, P., Oostenbrink, J., Zuurbier, J.Schaepkens, F. (2007), ‘The risk of upcoding in casemix systems: a comparative study’, Health Policy, 81(2): 289–299.CrossRefGoogle ScholarPubMed
Thomson, S., Foubister, T., Mossialos, E. (2009), Financing Health Care in the European Union. Challenges and Policy Responses. World Health Organization: European Observatory on Health Systems and Policies. Observatory Studies Series No. 17, 42–43, Copenhagen.Google Scholar
van Barneveld, E., Lamers, L. M., van Vliet, R.van de Ven, W. (2001), ‘Risk sharing as a supplement to imperfect capitation: a trade-off between selection and efficiency’, Journal of Health Economics, 20: 147–168.Google Scholar
Vitikainen, K., Street, A.Linna, M. (2009), ‘Estimation of hospital efficiency – do different definitions and casemix measures for hospital output affect the results’, Health Policy, 89(2): 149–159.Google Scholar
Vuorenkoski, L. (2008), Finland: Health System Review, in P. Mladovsky and E. Mossialos (eds), Health Systems in Transition, vol. 10, no. 4. Copenhagen: European Observatory on Health Systems and Policies Series, 1–170.Google Scholar
Wilke, M., Höcherl, E., Scherer, J.Janke, L. (2001), ‘Introducing the new DRG-based payment system in German hospitals: a difficult operation?’, Health Care Systems in Europe, 2: 79–85.Google Scholar