Are English treatment centres treating less complex patients?
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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- 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.
- Leemore S. Dafny, 2005. "How Do Hospitals Respond to Price Changes?," American Economic Review, American Economic Association, vol. 95(5), pages 1525-1547, December.
- 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.
- Deneffe, Daniel & Masson, Robert T., 2002. "What do not-for-profit hospitals maximize?," International Journal of Industrial Organization, Elsevier, vol. 20(4), pages 461-492, April.
- Chalkley, M. & Malcomson, J.M., 1995.
"Contracting for health services with unmonitored quality,"
Discussion Paper Series In Economics And Econometrics
9510, Economics Division, School of Social Sciences, University of Southampton.
- 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.
- Mark McClellan, 1997. "Hospital Reimbursement Incentives: An Empirical Analysis," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 6(1), pages 91-128, 03.
- 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.
- 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.
- Newhouse, Joseph P., 1982. "Is competition the answer?," Journal of Health Economics, Elsevier, vol. 1(1), pages 109-116, May.
- Gian Paolo Barbetta & Gilberto Turati & Angelo M. Zago, 2007. "Behavioral differences between public and private not-for-profit hospitals in the Italian national health service," Health Economics, John Wiley & Sons, Ltd., vol. 16(1), pages 75-96.
- Silverman, Elaine & Skinner, Jonathan, 2004. "Medicare upcoding and hospital ownership," Journal of Health Economics, Elsevier, vol. 23(2), pages 369-389, March.
- Ellis, Randall P. & Vidal-Fernández, Marian, 2007. "Activity-based payments and reforms of the English hospital payment system," Health Economics, Policy and Law, Cambridge University Press, vol. 2(04), pages 435-444, October.
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