The quicker the better: Fostering timely responses in public hospitals

Pre-surgery waiting times are viewed as a process indicator of the quality of care for hip fracture surgeries. International clinical guidelines recommend that these treatments are performed within two days after hospitalisation. In year 2011, the Italy’s EmiliaRomagna region incentivised hospitals to achieve the target of two days for pre-surgery waiting times, by allowing the chief executives of Local Health Authorities and hospital Trusts to receive greater rewards if they managed to achieve a higher proportion of hip fracture patients treated within the threshold. We analyse the effect of this policy by applying a difference-in-differences estimation strategy on patient-level data between 2007 and 2016. We find that the introduction of managerial incentives reduced hip fracture surgery delays with differences between the treated and control groups increasing over time. There is also evidence of a convergence in the pre-operative waiting times across hospitals, with those experiencing longer surgery delays in the pre-policy period achieving the greatest reductions after policy implementation. Finally, our findings lend support to the hypothesis that hospitals reacted to the policy by targeting patients with less severe health conditions as recorded at the time of hospital admission.