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Can Payers Use Prices to Improve Quality? Evidence from English Hospitals

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  • Thomas Allen
  • Eleonora Fichera
  • Matt Sutton

Abstract

In most activity‐based financing systems, payers set prices reactively based on historical averages of hospital reported costs. If hospitals respond to prices, payers might set prices proactively to affect the volume of particular treatments or clinical practice. We evaluate the effects of a unique initiative in England in which the price offered to hospitals for discharging patients on the same day as a particular procedure was increased by 24%, while the price for inpatient treatment remained unchanged. Using national hospital records for 205 784 patients admitted for the incentivised procedure and 838 369 patients admitted for a range of non‐incentivised procedures between 1 December 2007 and 31 March 2011, we consider whether this price change had the intended effect and/or produced unintended effects. We find that the price change led to an almost six percentage point increase in the daycase rate and an 11 percentage point increase in the planned daycase rate. Patients benefited from a lower proportion of procedures reverted to open surgery during a planned laparoscopic procedure and from a reduction in long stays. There was no evidence that readmission and death rates were affected. The results suggest that payers can set prices proactively to incentivise hospitals to improve quality. Copyright © 2014 John Wiley & Sons, Ltd.

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  • Thomas Allen & Eleonora Fichera & Matt Sutton, 2016. "Can Payers Use Prices to Improve Quality? Evidence from English Hospitals," Health Economics, John Wiley & Sons, Ltd., vol. 25(1), pages 56-70, January.
    • Handle: RePEc:wly:hlthec:v:25:y:2016:i:1:p:56-70
    DOI: 10.1002/hec.3121
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    References listed on IDEAS

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    Cited by:

    1. 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).
    2. Fichera, Eleonora & Banks, James & Siciliani, Luigi & Sutton, Matt, 2018. "Does patient health behaviour respond to doctor effort?," Journal of Economic Behavior & Organization, Elsevier, vol. 156(C), pages 225-251.
    3. Huitfeldt, Ingrid, 2021. "Hospital reimbursement and capacity constraints: Evidence from orthopedic surgeries," Health Policy, Elsevier, vol. 125(6), pages 732-738.
    4. Rossella Verzulli & Gianluca Fiorentini & Matteo Lippi Bruni & Cristina Ugolini, 2017. "Price Changes in Regulated Healthcare Markets: Do Public Hospitals Respond and How?," Health Economics, John Wiley & Sons, Ltd., vol. 26(11), pages 1429-1446, November.
    5. Jurgita Januleviciute & Jan Erik Askildsen & Oddvar Kaarboe & Luigi Siciliani & Matt Sutton, 2016. "How do Hospitals Respond to Price Changes? Evidence from Norway," Health Economics, John Wiley & Sons, Ltd., vol. 25(5), pages 620-636, May.
    6. Feng, Yan & Kristensen, Søren Rud & Lorgelly, Paula & Meacock, Rachel & Sanchez, Marina Rodes & Siciliani, Luigi & Sutton, Matt, 2019. "Pay for performance for specialised care in England: Strengths and weaknesses," Health Policy, Elsevier, vol. 123(11), pages 1036-1041.
    7. Liu, Jiacheng & Wang, Yaojing & Yao, Yi, 2024. "Anticipated benefit termination and health care consumption responses: Evidence from a quasi-experiment," Journal of Economic Behavior & Organization, Elsevier, vol. 227(C).
    8. Kreutzberg, Anika & Eckhardt, Helene & Milstein, Ricarda & Busse, Reinhard, 2024. "International strategies, experiences, and payment models to incentivise day surgery," Health Policy, Elsevier, vol. 140(C).
    9. Valentelyte, Gintare & Keegan, Conor & Sorensen, Jan, 2023. "Hospital response to Activity-Based Funding and price incentives: Evidence from Ireland," Health Policy, Elsevier, vol. 137(C).
    10. Eleonora Fichera & James Banks & Luigi Siciliani & Matt Sutton, 2017. "Does Patient Health Behaviour respond to Doctor’s Effort?," Department of Economics Working Papers 62/17, University of Bath, Department of Economics.
    11. Piia Pekola & Ismo Linnosmaa & Hennamari Mikkola, 2017. "Assessing the effects of price regulation and freedom of choice on quality: evidence from the physiotherapy market," Health Economics Review, Springer, vol. 7(1), pages 1-16, December.

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