System-wide impacts of hospital payment reforms : evidence from central and eastern Europe and central Asia
AbstractAlthough 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.
Download InfoIf you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
Bibliographic InfoPaper provided by The World Bank in its series Policy Research Working Paper Series with number 4987.
Date of creation: 01 Jul 2009
Date of revision:
Health Monitoring&Evaluation; Health Systems Development&Reform; Health Economics&Finance; Health Law; Population Policies;
Other versions of this item:
- Moreno-Serra, Rodrigo & Wagstaff, Adam, 2010. "System-wide impacts of hospital payment reforms: Evidence from Central and Eastern Europe and Central Asia," Journal of Health Economics, Elsevier, vol. 29(4), pages 585-602, July.
- C72 - Mathematical and Quantitative Methods - - Game Theory and Bargaining Theory - - - Noncooperative Games
- D82 - Microeconomics - - Information, Knowledge, and Uncertainty - - - Asymmetric and Private Information; Mechanism Design
- L14 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - Transactional Relationships; Contracts and Reputation
This paper has been announced in the following NEP Reports:
- NEP-ALL-2009-07-11 (All new papers)
- NEP-HEA-2009-07-11 (Health Economics)
- NEP-TRA-2009-07-11 (Transition Economics)
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- David M. Cutler, 1993.
"The Incidence of Adverse Medical Outcomes Under Prospective Payments,"
NBER Working Papers
4300, National Bureau of Economic Research, Inc.
- Cutler, David M, 1995. "The Incidence of Adverse Medical Outcomes under Prospective Payment," Econometrica, Econometric Society, vol. 63(1), pages 29-50, January.
- Cutler, D.M., 1992. "The Incidence of Adverse Medical Outcome Under Prospective Payment," Harvard Institute of Economic Research Working Papers 1603, Harvard - Institute of Economic Research.
- Davis, Carolyne K. & Rhodes, Deborah J., 1988. "The impact of DRGs on the cost and quality of health care in the United States," Health Policy, Elsevier, vol. 9(2), pages 117-131, April.
- Hodgkin, Dominic & McGuire, Thomas G., 1994. "Payment levels and hospital response to prospective payment," Journal of Health Economics, Elsevier, vol. 13(1), pages 1-29, March.
- Jegers, Marc & Kesteloot, Katrien & De Graeve, Diana & Gilles, Willem, 2002. "A typology for provider payment systems in health care," Health Policy, Elsevier, vol. 60(3), pages 255-273, June.
- Gerdtham, Ulf-G. & Rehnberg, Clas & Tambour, Magnus, 1997.
"The Impact of Internal Markets on Health Care Efficiency: Evidence from Health Care Reforms in Sweden,"
Working Paper Series in Economics and Finance
170, Stockholm School of Economics.
- U. -G. Gerdtham & C. Rehnberg & M. Tambour, 1999. "The impact of internal markets on health care efficiency: evidence from health care reforms in Sweden," Applied Economics, Taylor & Francis Journals, vol. 31(8), pages 935-945.
- 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.
- Marianne Bertrand & Esther Duflo & Sendhil Mullainathan, 2002.
"How Much Should We Trust Differences-in-Differences Estimates?,"
NBER Working Papers
8841, National Bureau of Economic Research, Inc.
- Marianne Bertrand & Esther Duflo & Sendhil Mullainathan, 2004. "How Much Should We Trust Differences-in-Differences Estimates?," The Quarterly Journal of Economics, MIT Press, vol. 119(1), pages 249-275, February.
- Wagstaff, Adam & Moreno-Serra, Rodrigo, 2009. "Europe and central Asia's great post-communist social health insurance experiment: Aggregate impacts on health sector outcomes," Journal of Health Economics, Elsevier, vol. 28(2), pages 322-340, March.
- Marini, Giorgia & Street, Andrew, 2007. "A transaction costs analysis of changing contractual relations in the English NHS," Health Policy, Elsevier, vol. 83(1), pages 17-26, September.
- Ellis, Randall P. & McGuire, Thomas G., 1986. "Provider behavior under prospective reimbursement : Cost sharing and supply," Journal of Health Economics, Elsevier, vol. 5(2), pages 129-151, June.
- Adam Wagstaff & Eddy van Doorslaer, 2003. "Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993-1998," Health Economics, John Wiley & Sons, Ltd., vol. 12(11), pages 921-933.
- Gérard Roland, 2000.
"Transition and Economics: Politics, Markets, and Firms,"
MIT Press Books,
The MIT Press,
edition 1, volume 1, number 0262182033, December.
- Gérard Roland, 2004. "Transition and Economics: Politics, Markets, and Firms," MIT Press Books, The MIT Press, edition 1, volume 1, number 026268148x, December.
- Kroneman, Madelon & Nagy, Julia, 2001. "Introducing DRG-based financing in Hungary: a study into the relationship between supply of hospital beds and use of these beds under changing institutional circumstances," Health Policy, Elsevier, vol. 55(1), pages 19-36, January.
- 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.
- Lang, Hui-Chu & Chi, Chunhuei & Liu, Chi-Ming, 2004. "Impact of the case payment reimbursement method on the utilization and costs of laparoscopic cholecystectomy," Health Policy, Elsevier, vol. 67(2), pages 195-206, February.
- Winnie Yip & Karen Eggleston, 2001. "Provider payment reform in China: the case of hospital reimbursement in Hainan province," Health Economics, John Wiley & Sons, Ltd., vol. 10(4), pages 325-339.
- Leemore S. Dafny, 2005. "How Do Hospitals Respond to Price Changes?," American Economic Review, American Economic Association, vol. 95(5), pages 1525-1547, December.
- 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, vol. 6(3), pages 339-360, August.
- Brian Bell & Richard Blundell & John Van Reenen, 1999. "Getting the unemployed back to work: the role of targeted wage subsidies," IFS Working Papers W99/12, Institute for Fiscal Studies.
- Gerdtham, Ulf-G. & Jonsson, Bengt, 2000. "International comparisons of health expenditure: Theory, data and econometric analysis," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 1, pages 11-53 Elsevier.
- C. E. Dismuke & P. Guimaraes, 2002. "Has the caveat of case-mix based payment influenced the quality of inpatient hospital care in Portugal?," Applied Economics, Taylor & Francis Journals, vol. 34(10), pages 1301-1307.
- Cheng, Amy H.Y. & Sutherland, Jason M., 2013. "British Columbia's pay-for-performance experiment: Part of the solution to reduce emergency department crowding?," Health Policy, Elsevier, vol. 113(1), pages 86-92.
- Philippe Choné & Franck Evain & Lionel Wilner & Engin Yilmaz, 2013.
"Introducing Activity-Based Payment in the Hospital Industry: Evidence from French Data,"
CESifo Working Paper Series
4304, CESifo Group Munich.
- P. Choné & F. Evain & L. Wilner & E. Yilmaz, 2013. "Introducing activity-based payment in the hospital industry: Evidence from French data," Documents de Travail de la DESE - Working Papers of the DESE g2013-11, Institut National de la Statistique et des Etudes Economiques, DESE.
- Nguyen, Ha Thi Hong & Bales, Sarah & Wagstaff, Adam & Dao, Huyen, 2013. "Getting incentives right : an impact evaluation of district hospital capitation payment in Vietnam," Policy Research Working Paper Series 6709, The World Bank.
- Gao, Chen & Xu, Fei & Liu, Gordon G., 2014. "Payment reform and changes in health care in China," Social Science & Medicine, Elsevier, vol. 111(C), pages 10-16.
- Hamada, Hironori & Sekimoto, Miho & Imanaka, Yuichi, 2012. "Effects of the per diem prospective payment system with DRG-like grouping system (DPC/PDPS) on resource usage and healthcare quality in Japan," Health Policy, Elsevier, vol. 107(2), pages 194-201.
- Guccio, Calogero & Lisi, Domenico & Pignataro, Giacomo, 2014. "Readmission and Hospital Quality under Prospective Payment System," MPRA Paper 56490, University Library of Munich, Germany.
- Aoife Brick & Anne Nolan & Jacqueline O’Reilly & Samantha Smith, 2012. "Conflicting Financial Incentives in the Irish Health-Care System," The Economic and Social Review, Economic and Social Studies, vol. 43(2), pages 273â301.
- Bogut, Martina & Voncina, Luka & Yeh, Ethan, 2012. "Impact of hospital provider payment reforms in Croatia," Policy Research Working Paper Series 5992, The World Bank.
- Cheng, Shou-Hsia & Chen, Chi-Chen & Tsai, Shu-Ling, 2012. "The impacts of DRG-based payments on health care provider behaviors under a universal coverage system: A population-based study," Health Policy, Elsevier, vol. 107(2), pages 202-208.
- Owen Smith & Son Nam Nguyen, 2013. "Getting Better : Improving Health System Outcomes in Europe and Central Asia," World Bank Publications, The World Bank, number 13832, October.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Roula I. Yazigi).
If references are entirely missing, you can add them using this form.