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Should prospective payments be differentiated for public and private healthcare providers?

Published online by Cambridge University Press:  01 October 2009

ANNE MASON ,
ANDREW STREET ,
MARISA MIRALDO  and
LUIGI SICILIANI
ANNE MASON*
Affiliation:
Research Fellow, Centre for Health Economics, University of York, UK
ANDREW STREET
Affiliation:
Professor, Centre for Health Economics, University of York, UK
MARISA MIRALDO
Affiliation:
Lecturer, Imperial College Business School, London, UK
LUIGI SICILIANI
Affiliation:
Senior Lecturer, Centre for Health Economics, and Department of Economics and Related Studies, University of York, UK
*
*Corresponding author: Anne R. Mason, Research Fellow, Alcuin A Block, Centre for Health Economics, University of York, York YO10 5DD, UK. Email: arm10@york.ac.uk
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Abstract

The English government has encouraged private providers – known as Independent Sector Treatment Centres (ISTCs) – to treat publicly funded (NHS) patients. All providers are to be remunerated under a prospective payment system that offers a price per case treated, adjusted by the Market Forces Factor (MFF) to reflect geographical variation in specific input costs. This payment system presupposes that any remaining cost differentials between providers result from inefficiencies. However, the validity of this assumption is unclear. This article describes the constraints that could cause public and private provider costs to differ for reasons outside their control. These constraints may be regulatory in nature, such as taxes and performance management regimens, or relate to the production process, such as input costs, the provision of emergency care, and case mix issues. Most of these exogenous cost differentials can be rectified by adjustments either to the regulatory system or to the payment method. However, differences in capital costs appear less tractable and further investigation into possible solutions is warranted.

Type
Articles
Information
Health Economics, Policy and Law , Volume 4 , Issue 4 , October 2009 , pp. 383 - 403
Copyright
Copyright © Cambridge University Press 2009

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References

Aballea, P., Bras, P., and Seydoux, S. (2006), ‘Mission d'apui sur la convergence tarifaire public privé', Rapport no. 2006 009, Inspection Générale des Affaires Sociales, Paris.Google Scholar
Audit Commission (2005), Early Lessons from Payment by Results, London: Audit Commission.Google Scholar
Bagust, A., Place, M., and Posnett, J.J. (1999), ‘Dynamics of bed use in accommodating emergency admissions: stochastic simulation model', British Medical Journal, 319: 155–158.CrossRefGoogle ScholarPubMed
Barron, K., Hewitt, P., Carruthers, S.I., Taylor, H., Kirkup, B., Searle, G., and House of Commons Health Committee (2006), Independent Sector Treatment Centres: Fourth Report of Session 2005–06. Volume III: Oral and Written Evidence, London: The Stationery Office.Google Scholar
Barron, K. and House of Commons Health Committee (2006), Independent Sector Treatment Centres: Fourth Report of Session 2005–06. Volume I: Report, together with Formal Minutes, London: The Stationery Office.Google Scholar
CBI and Serco Institute (2006), A Fair Field and no Favours: Competitive Neutrality in UKPublic Service Markets, London: Serco Institute.Google Scholar
Department of Health (2004), Reconfiguring the Department of Health's Arm's Length Bodies, London: Department of Health.Google Scholar
Department of Health (2005), Independent Sector Procurement Programme – Wave 2 NHS Equivalent Cost Methodology, Commercial Directorate, London: Department of Health.Google Scholar
Department of Health (2006a), The Government's Response to the Health Committee's Report on Independent Sector Treatment Centres, London: Department of Health.Google Scholar
Department of Health (2006b), ISTC Manual, London: Department of Health.Google Scholar
Department of Health (2006c), ‘Options for the future of Payment by Results: 2008/09 and beyond', Consultation document, Draft (15/12/06), Department of Health, London.Google Scholar
Department of Health (2006d), ‘Payment by Results guidance 2007–08', Version 1, Department of Health, Leeds.Google Scholar
Department of Health (2006e), Rules for Independent Sector Participants in the Independent Sector Extended Choice Network, London: Department of Health.Google Scholar
Department of Health (2007a), Choice at Referral – Guidance Framework for 2007/08, London: Department of Health.Google Scholar
Department of Health (2007b), Departmental Report 2007, London: Department of Health.Google Scholar
Department of Health (2007c), Impact Assessments for the Health and Social Care Bill, London: Department of Health.Google Scholar
Department of Health (2007d), Options for the Future of Payment by Results: 2008/09 to 2010/11, London: Department of Health.Google Scholar
Department of Health and Central Clinical Procurement Programme team (2007), Independent Sector Programme Phase 2: Electives, Full Business Case for Scheme X, London: Department of Health.Google Scholar
Dranove, D. (1987), ‘Rate-setting by diagnosis related groups and hospital specialization', RAND Journal of Economics, 18: 417–427.CrossRefGoogle Scholar
Ellis, R. and Vidal-Fernández, M. (2007), ‘Activity-based payments and reforms of the English hospital payment system', Health Economics Policy and Law, 2: 435–444.CrossRefGoogle ScholarPubMed
Gaffney, D., Pollock, A. M., Price, D., and Shaoul, J. (1999), ‘The private finance initiative: NHS capital expenditure and the private finance initiative – expansion or contraction?', British Medical Journal, 319: 48–51.CrossRefGoogle ScholarPubMed
Gainsbury, S. (2008), ‘ISTC contract guarantees will saddle NHS with a £187m bill', Health Service Journal (6 March): 4–5.Google Scholar
Hawe, E. (2008), OHE Compendium of Health Statistics, 19th edition, Abingdon: Radcliffe Publishing Ltd.Google Scholar
Healthcare Commission (2006), Regulatory Fees for the Independent Healthcare Sector in 2007/2008, London: Commission for Healthcare Audit and Inspection.Google Scholar
Healthcare Commission (2007), Independent Sector Treatment Centres: A Review of the Quality of Care, London: Commission for Healthcare Audit and Inspection.Google Scholar
HM Treasury (2005), ‘Financial Reporting Advisory Board Paper FRAB (75) 04: Classification of PDC', HM Treasury, London.Google Scholar
House of Commons Committee of Public Accounts (2007), Department of Health: The National Programme for IT in the NHS, Twentieth Report of Session 2006–07, London: The Stationery Office.Google Scholar
Kendall, G. and NHS Partners Network (2007a), ‘Payment by results', Personal communication, 5 June.Google Scholar
Kendall, G. and NHS Partners Network (2007b), ‘Quantified cost differentials', Personal communication, 12 August.Google Scholar
Marini, G. and Street, A. (2007), ‘A transaction costs analysis of changing contractual relations in the English NHS', Health Policy, 83: 17–26.CrossRefGoogle ScholarPubMed
Mason, A., Miraldo, M.Siciliani, L.Sivey, P., and Street, A. (2008), Establishing a Fair Playing Field for Payment by Results: CHE Research Paper 39, York: University of York.Google Scholar
Monitor (2005), ‘Prudential Borrowing Code (PBC) for NHS Foundation Trusts', available at: http://www.monitor-nhsft.gov.uk/documents/Prudential_Borrowing_Code_March05.pdf.Google Scholar
National Audit Office (2006), Department of Health: The National Programme for IT in the NHS, Report by the Comptroller and Auditor General / HC 1173 Session 2005–2006, London: The Stationery Office.Google Scholar
National Audit Office (2007), Pay Modernisation: A New Contract for NHS Consultants in England, London: The Stationery Office.Google Scholar
National Audit Office (2008), Making Changes in Operational PFI Projects, London: The Stationery Office.Google Scholar
NHS Connecting for Health (2005), ‘Business plan 2005/06', available at: http://www.connectingforhealth.nhs.uk/resources/nhs_cfh_business_plan.pdf.Google Scholar
Office of Fair Trading (2004), ‘Public subsidies', available at: http://www.oft.gov.uk/shared_oft/reports/comp_policy/oft750.pdf.Google Scholar
Office of Public Sector Information (2008), Health and Social Care Act 2008: Elizabeth II – Chapter 14, London: The Stationery Office.Google Scholar
Palmer, K. (2006), NHS Reform: Getting Back on Track, London: King's Fund.Google Scholar
Pollock, A. M., Shaoul, J., and Vickers, N. (2002), ‘Private finance and “value for money” in NHS hospitals: a policy in search of a rationale?', British Medical Journal, 324: 1205–1209.CrossRefGoogle ScholarPubMed
PriceWaterhouseCoopers LLP (2005a), Level Playing Field Issues in Accreditation, Department of Health Commercial Directorate.Google Scholar
PriceWaterhouseCoopers LLP (2005b), Report on Altmark Criteria, PricewaterhouseCoopers.Google Scholar
Shaoul, J., Stafford, A., and Stapleton, P. (2008), ‘The cost of using private finance to build, finance and operate the first 12 NHS hospitals in England', Public Money and Management, 28: 101–108.CrossRefGoogle Scholar
Shleifer, A. (1985), ‘A theory of yardstick competition', RAND Journal of Economics, 16: 319–327.CrossRefGoogle Scholar
Siciliani, L. and Hurst, J. (2005), ‘Tackling excessive waiting times for elective surgery: a comparative analysis of policies in 12 OECD countries', Health Policy, 72: 201–215.CrossRefGoogle ScholarPubMed