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Are English treatment centres treating less complex patients?

Author

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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.

Suggested Citation

  • Street, Andrew & Sivey, Peter & Mason, Anne & Miraldo, Marisa & Siciliani, Luigi, 2010. "Are English treatment centres treating less complex patients?," Health Policy, Elsevier, vol. 94(2), pages 150-157, February.
  • Handle: RePEc:eee:hepoli:v:94:y:2010:i:2:p:150-157
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    References listed on IDEAS

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    Cited by:

    1. Adriana Castelli & Andrew Street & Rossella Verzulli & Padraic Ward, 2015. "Examining variations in hospital productivity in the English NHS," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(3), pages 243-254, April.
    2. repec:eee:socmed:v:196:y:2018:i:c:p:166-174 is not listed on IDEAS
    3. Giuseppe Moscelli & Hugh Gravelle & Luigi Siciliani, 2016. "Market structure, patient choice and hospital quality for elective patients," Working Papers 139cherp, Centre for Health Economics, University of York.
    4. Daidone, Silvio & Street, Andrew, 2013. "How much should be paid for specialised treatment?," Social Science & Medicine, Elsevier, vol. 84(C), pages 110-118.
    5. Pérotin, Virginie & Zamora, Bernarda & Reeves, Rachel & Bartlett, Will & Allen, Pauline, 2013. "Does hospital ownership affect patient experience? An investigation into public–private sector differences in England," Journal of Health Economics, Elsevier, vol. 32(3), pages 633-646.
    6. Cooper, Zack & Gibbons, Stephen & Skellern, Matthew, 2016. "Does competition from private surgical centres improve public hospitals’ performance? Evidence from the English National Health Service," LSE Research Online Documents on Economics 67662, London School of Economics and Political Science, LSE Library.
    7. 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.
    8. Luigi Siciliani & Peter Sivey & Andrew Street, 2011. "Differences in Length of Stay between Public Hospitals, Treatment Centres and Private Providers: Selection or Efficiency?," Melbourne Institute Working Paper Series wp2011n06, Melbourne Institute of Applied Economic and Social Research, The University of Melbourne.
    9. Chris Bojke & Adriana Castelli & Andrew Street & Padraic Ward & Mauro Laudicella, 2013. "Regional Variation In The Productivity Of The English National Health Service," Health Economics, John Wiley & Sons, Ltd., vol. 22(2), pages 194-211, February.
    10. 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.
    11. Cheng, Terence C. & Haisken-DeNew, John P. & Yong, Jongsay, 2015. "Cream skimming and hospital transfers in a mixed public-private system," Social Science & Medicine, Elsevier, vol. 132(C), pages 156-164.

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