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Reimbursement Schemes for Hospitals: The Impact of Case and Firm Characteristics

Listed author(s):
  • Wohlschlegel, Ansgar
  • Feess, Eberhard
  • Mueller, Helge

We use data from a German health insurer to study how the impact of switching from a fee for service system (FFS) to a high powered incentive scheme (prospective payment system; PPS) depends on the characteristics of patients and hospitals. As hospitals had a transition period of several years to complete the switch, we can adopt a difference-in-differences approach by adding hospital fixed effects and a time trend. Our results support hypotheses drawn from an incentive and selection perspective: PPS reduces the length of stay of older relative to younger patients, of more severe relative to less severe cases, and in smaller relative to larger hospitals. Hospitals which adopted PPS earlier provide higher quality under PPS as proxied by the case-specific readmission rate.

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File URL: https://www.econstor.eu/bitstream/10419/162045/1/Hospital_June2017.pdf
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Paper provided by Verein für Socialpolitik / German Economic Association in its series Annual Conference 2016 (Augsburg): Demographic Change with number 145776.

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Date of creation: 2017
Handle: RePEc:zbw:vfsc16:145776
Contact details of provider: Web page: http://www.socialpolitik.org/
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  1. 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.
  2. Ellis, Randall P. & McGuire, Thomas G., 1996. "Hospital response to prospective payment: Moral hazard, selection, and practice-style effects," Journal of Health Economics, Elsevier, vol. 15(3), pages 257-277, June.
  3. Leemore S. Dafny, 2005. "How Do Hospitals Respond to Price Changes?," American Economic Review, American Economic Association, vol. 95(5), pages 1525-1547, December.
  4. 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.
  5. Mark Armstrong & David E.M. Sappington, 2006. "Regulation, Competition and Liberalization," Journal of Economic Literature, American Economic Association, vol. 44(2), pages 325-366, June.
  6. Reinhard Busse & Jonas Schreyögg & Peter C. Smith, 2008. "Variability in healthcare treatment costs amongst nine EU countries - results from the Health BASKET project," Health Economics, John Wiley & Sons, Ltd., vol. 17(S1), pages 1-8.
  7. Cutler, David M, 1995. "The Incidence of Adverse Medical Outcomes under Prospective Payment," Econometrica, Econometric Society, vol. 63(1), pages 29-50, January.
  8. Martin Gaynor & Rodrigo Moreno-Serra & Carol Propper, 2013. "Death by Market Power: Reform, Competition, and Patient Outcomes in the National Health Service," American Economic Journal: Economic Policy, American Economic Association, vol. 5(4), pages 134-166, November.
  9. Tom Stargardt, 2008. "Health service costs in Europe: cost and reimbursement of primary hip replacement in nine countries," Health Economics, John Wiley & Sons, Ltd., vol. 17(S1), pages 9-20.
  10. Jiale Zhang, 2010. "The impact of a diagnosis-related group-based prospective payment experiment: the experience of Shanghai," Applied Economics Letters, Taylor & Francis Journals, vol. 17(18), pages 1797-1803.
  11. Crew, Michael A & Kleindorfer, Paul R, 2002. "Regulatory Economics: Twenty Years of Progress?," Journal of Regulatory Economics, Springer, vol. 21(1), pages 5-22, January.
  12. 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.
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