IDEAS home Printed from https://ideas.repec.org/a/wly/hlthec/v31y2022i6p956-972.html
   My bibliography  Save this article

The long‐run effects of diagnosis related group payment on hospital lengths of stay in a publicly funded health care system: Evidence from 15 years of micro data

Author

Listed:
  • María José Aragón
  • Martin Chalkley
  • Noémi Kreif

Abstract

Diagnosis Related Group (DRG) payment systems are a common means of paying for hospital services. They reward greater activity and therefore potentially encourage more rapid treatment. This paper uses 15 years of administrative data to examine the impact of a DRG system introduced in England on hospital lengths of stay. We utilize different econometric models, exploiting within and cross jurisdiction variation, to identify policy effects, finding that the reduction of lengths of stay was greater than previously estimated and grew over time. This constitutes new and important evidence of the ability of financing reform to generate substantial and persistent change in healthcare delivery.

Suggested Citation

  • María José Aragón & Martin Chalkley & Noémi Kreif, 2022. "The long‐run effects of diagnosis related group payment on hospital lengths of stay in a publicly funded health care system: Evidence from 15 years of micro data," Health Economics, John Wiley & Sons, Ltd., vol. 31(6), pages 956-972, June.
    • Handle: RePEc:wly:hlthec:v:31:y:2022:i:6:p:956-972
    DOI: 10.1002/hec.4479
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hec.4479
    Download Restriction: no
    File URL: https://libkey.io/10.1002/hec.4479?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Karen S Palmer & Thomas Agoritsas & Danielle Martin & Taryn Scott & Sohail M Mulla & Ashley P Miller & Arnav Agarwal & Andrew Bresnahan & Afeez Abiola Hazzan & Rebecca A Jeffery & Arnaud Merglen & Ahm, 2014. "Activity-Based Funding of Hospitals and Its Impact on Mortality, Readmission, Discharge Destination, Severity of Illness, and Volume of Care: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-1, October.
    2. Dmitry Arkhangelsky & Susan Athey & David A. Hirshberg & Guido W. Imbens & Stefan Wager, 2021. "Synthetic Difference-in-Differences," American Economic Review, American Economic Association, vol. 111(12), pages 4088-4118, December.
    3. Alberto Abadie & Alexis Diamond & Jens Hainmueller, 2015. "Comparative Politics and the Synthetic Control Method," American Journal of Political Science, John Wiley & Sons, vol. 59(2), pages 495-510, February.
    4. Emma Hawe;Lesley Cockcroft, 2013. "OHE Guide to UK Health and Health Care Statistics," Monograph 000003, Office of Health Economics.
    5. Chalkley, Martin & Malcomson, James M, 1998. "Contracting for Health Services with Unmonitored Quality," Economic Journal, Royal Economic Society, vol. 108(449), pages 1093-1110, July.
    6. Ma, Ching-to Albert, 1994. "Health Care Payment Systems: Cost and Quality Incentives," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 3(1), pages 93-112, Spring.
    7. Joshua D. Angrist & Jörn-Steffen Pischke, 2009. "Mostly Harmless Econometrics: An Empiricist's Companion," Economics Books, Princeton University Press, edition 1, number 8769.
    8. Noémi Kreif & Richard Grieve & Dominik Hangartner & Alex James Turner & Silviya Nikolova & Matt Sutton, 2016. "Examination of the Synthetic Control Method for Evaluating Health Policies with Multiple Treated Units," Health Economics, John Wiley & Sons, Ltd., vol. 25(12), pages 1514-1528, December.
    9. Marianne Bertrand & Esther Duflo & Sendhil Mullainathan, 2004. "How Much Should We Trust Differences-In-Differences Estimates?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 119(1), pages 249-275.
    10. Nonnemaker, James M. & Farrelly, Matthew C., 2011. "Smoking initiation among youth: The role of cigarette excise taxes and prices by race/ethnicity and gender," Journal of Health Economics, Elsevier, vol. 30(3), pages 560-567, May.
    11. Meng, Zhaolin & Hui, Wen & Cai, Yuanyi & Liu, Jiazhou & Wu, Huazhang, 2020. "The effects of DRGs-based payment compared with cost-based payment on inpatient healthcare utilization: A systematic review and meta-analysis," Health Policy, Elsevier, vol. 124(4), pages 359-367.
    12. Carpenter, Christopher S. & Stehr, Mark, 2008. "The effects of mandatory seatbelt laws on seatbelt use, motor vehicle fatalities, and crash-related injuries among youths," Journal of Health Economics, Elsevier, vol. 27(3), pages 642-662, May.
    13. Brian Bell & Richard Blundell & John Reenen, 1999. "Getting the Unemployed Back to Work: The Role of Targeted Wage Subsidies," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 6(3), pages 339-360, August.
    14. Abadie, Alberto & Diamond, Alexis & Hainmueller, Jens, 2010. "Synthetic Control Methods for Comparative Case Studies: Estimating the Effect of California’s Tobacco Control Program," Journal of the American Statistical Association, American Statistical Association, vol. 105(490), pages 493-505.
    15. Wen, Hefei & Hockenberry, Jason M. & Cummings, Janet R., 2015. "The effect of medical marijuana laws on adolescent and adult use of marijuana, alcohol, and other substances," Journal of Health Economics, Elsevier, vol. 42(C), pages 64-80.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Dennis Shen & Peng Ding & Jasjeet Sekhon & Bin Yu, 2022. "Same Root Different Leaves: Time Series and Cross-Sectional Methods in Panel Data," Papers 2207.14481, arXiv.org, revised Oct 2022.
    2. David Gilchrist & Thomas Emery & Nuno Garoupa & Rok Spruk, 2023. "Synthetic Control Method: A tool for comparative case studies in economic history," Journal of Economic Surveys, Wiley Blackwell, vol. 37(2), pages 409-445, April.
    3. Taylor K. Odle, 2022. "Free to Spend? Institutional Autonomy and Expenditures on Executive Compensation, Faculty Salaries, and Research Activities," Research in Higher Education, Springer;Association for Institutional Research, vol. 63(1), pages 1-32, February.
    4. Bruno Ferman & Cristine Pinto & Vitor Possebom, 2020. "Cherry Picking with Synthetic Controls," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 39(2), pages 510-532, March.
    5. Peter Backus & Thien Nguyen, 2021. "The Effect of the Sex Buyer Law on the Market for Sex, Sexual Health and Sexual Violence," Economics Discussion Paper Series 2106, Economics, The University of Manchester.
    6. Taylor K. Odle & Jennifer A. Delaney, 2022. "You are Admitted! Early Evidence on Enrollment from Idaho’s Direct Admissions System," Research in Higher Education, Springer;Association for Institutional Research, vol. 63(6), pages 899-932, September.
    7. Huang, Hongyun & Mbanyele, William & Wang, Fengrong & Song, Malin & Wang, Yuzhang, 2022. "Climbing the quality ladder of green innovation: Does green finance matter?," Technological Forecasting and Social Change, Elsevier, vol. 184(C).
    8. Alexander S. Skorobogatov, 2021. "The effect of alcohol sales restrictions on alcohol poisoning mortality: Evidence from Russia," Health Economics, John Wiley & Sons, Ltd., vol. 30(6), pages 1417-1442, June.
    9. Eli Ben‐Michael & Avi Feller & Jesse Rothstein, 2022. "Synthetic controls with staggered adoption," Journal of the Royal Statistical Society Series B, Royal Statistical Society, vol. 84(2), pages 351-381, April.
    10. Denti, Daria & Iammarino, Simona, 2022. "Coming Out of the Woods. Do local support services influence the propensity to report sexual violence?," Journal of Economic Behavior & Organization, Elsevier, vol. 193(C), pages 334-352.
    11. Lea Bottmer & Guido Imbens & Jann Spiess & Merrill Warnick, 2021. "A Design-Based Perspective on Synthetic Control Methods," Papers 2101.09398, arXiv.org, revised Jul 2023.
    12. Dmitry Arkhangelsky & Guido Imbens, 2023. "Causal Models for Longitudinal and Panel Data: A Survey," Papers 2311.15458, arXiv.org, revised Mar 2024.
    13. Roth, Jonathan & Sant’Anna, Pedro H.C. & Bilinski, Alyssa & Poe, John, 2023. "What’s trending in difference-in-differences? A synthesis of the recent econometrics literature," Journal of Econometrics, Elsevier, vol. 235(2), pages 2218-2244.
    14. Bibek Adhikari & James Alm, 2016. "Evaluating the Economic Effects of Flat Tax Reforms Using Synthetic Control Methods," Southern Economic Journal, John Wiley & Sons, vol. 83(2), pages 437-463, October.
    15. Olper, Alessandro & Curzi, Daniele & Swinnen, Johan, 2018. "Trade liberalization and child mortality: A Synthetic Control Method," World Development, Elsevier, vol. 110(C), pages 394-410.
    16. Jason Poulos & Shuxi Zeng, 2021. "RNN‐based counterfactual prediction, with an application to homestead policy and public schooling," Journal of the Royal Statistical Society Series C, Royal Statistical Society, vol. 70(4), pages 1124-1139, August.
    17. Gaughan, James & Gutacker, Nils & Grašič, Katja & Kreif, Noemi & Siciliani, Luigi & Street, Andrew, 2019. "Paying for efficiency: Incentivising same-day discharges in the English NHS," Journal of Health Economics, Elsevier, vol. 68(C).
    18. Fredriksen, Kaja & Runst, Petrik, 2018. "Are estimates of the "natural experiment" in the German crafts sector causal?," ifh Working Papers 16/2018, Volkswirtschaftliches Institut für Mittelstand und Handwerk an der Universität Göttingen (ifh).
    19. Sunil Mithas & Yanzhen Chen & Yatang Lin & Alysson De Oliveira Silveira, 2022. "On the causality and plausibility of treatment effects in operations management research," Production and Operations Management, Production and Operations Management Society, vol. 31(12), pages 4558-4571, December.
    20. Luis Costa & Vivek F. Farias & Patricio Foncea & Jingyuan (Donna) Gan & Ayush Garg & Ivo Rosa Montenegro & Kumarjit Pathak & Tianyi Peng & Dusan Popovic, 2023. "Generalized Synthetic Control for TestOps at ABI: Models, Algorithms, and Infrastructure," Interfaces, INFORMS, vol. 53(5), pages 336-349, September.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:wly:hlthec:v:31:y:2022:i:6:p:956-972. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.