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Are English treatment centres treating less complex patients?

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  • Street, Andrew
  • Sivey, Peter
  • Mason, Anne
  • Miraldo, Marisa
  • Siciliani, Luigi

Abstract

Activity-based funding involves remunerating healthcare providers a fixed price per patient in each payment category. However, no categorisation system can account perfectly for differences in patient complexity. Differences may be systematic if providers routinely attract high-risk patients or engage in patient selection. Such differences may be evident in the English National Health Service (NHS) following the introduction of treatment centres that concentrate on providing a small number of high-volume procedures. We analyse data for more than 3.3 million patients to assess whether the complexity of those treated in hospitals and treatment centres differs within twenty-nine payment categories, defined by Healthcare Resource Groups (HRGs). We find that patients treated in hospitals were more likely to come from more deprived areas, to have more diagnoses and to undergo significantly more procedures than patients seen by treatment centres, suggesting that hospitals are treating more complex cases. If these observed differences between hospitals and treatment centres drive costs, then payments should be refined to ensure fair reimbursement.

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Bibliographic Info

Article provided by Elsevier in its journal Health Policy.

Volume (Year): 94 (2010)
Issue (Month): 2 (February)
Pages: 150-157

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Handle: RePEc:eee:hepoli:v:94:y:2010:i:2:p:150-157

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Web page: http://www.elsevier.com/locate/healthpol

Related research

Keywords: Hospitals Special Reimbursement mechanisms Prospective payment system Diagnosis-Related Groups;

References

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  1. Silverman, Elaine & Skinner, Jonathan, 2004. "Medicare upcoding and hospital ownership," Journal of Health Economics, Elsevier, vol. 23(2), pages 369-389, March.
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  6. Randall P. Ellis & Marian Vidal-Fernadez, 2007. "Response: Activity-Based Payments and Reforms of the English Hospital Payment System," Boston University - Department of Economics - Working Papers Series WP2007-035, Boston University - Department of Economics.
  7. Reinhard Busse & Jonas Schreyögg & Peter Smith, 2006. "Editorial: Hospital case payment systems in Europe," Health Care Management Science, Springer, vol. 9(3), pages 211-213, August.
  8. Kathryn Antioch & Randall Ellis & Steve Gillett & Daniel Borovnicar & Ric Marshall, 2007. "Risk adjustment policy options for casemix funding: international lessons in financing reform," The European Journal of Health Economics, Springer, vol. 8(3), pages 195-212, September.
  9. Ellis, Randall P., 1998. "Creaming, skimping and dumping: provider competition on the intensive and extensive margins1," Journal of Health Economics, Elsevier, vol. 17(5), pages 537-555, October.
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Cited by:
  1. Heijink, Richard & Mosca, Ilaria & Westert, Gert, 2013. "Effects of regulated competition on key outcomes of care: Cataract surgeries in the Netherlands," Health Policy, Elsevier, vol. 113(1), pages 142-150.
  2. Chris Bojke & Adriana Castelli & Mauro Laudicella & Andrew Street & Padraic Ward, 2010. "Regional variation in the productivity of the English National Health Service," Working Papers 057cherp, Centre for Health Economics, University of York.
  3. Daidone, Silvio & Street, Andrew, 2013. "How much should be paid for specialised treatment?," Social Science & Medicine, Elsevier, vol. 84(C), pages 110-118.
  4. Kim, Sun Jung & Park, Eun-Cheol & Jang, Sung In & Lee, Minjee & Kim, Tae Hyun, 2013. "An analysis of the inpatient charge and length of stay for patients with joint diseases in Korea: Specialty versus small general hospitals," Health Policy, Elsevier, vol. 113(1), pages 93-99.

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