Has payment by results affected the way that English hospitals provide care?

Difference-in-differences analysis

Shelley Farrar, Deokhee Yi, Matt Sutton, Martin Chalkley, Jon Sussex, Anthony Scott

Research output: Contribution to journalArticle

89 Citations (Scopus)

Abstract

Objective To examine whether the introduction of payment by results (a fixed tariff case mix based payment system) was associated with changes in key outcome variables measuring volume, cost, and quality of care between 2003/4 and 2005/6.

Setting Acute care hospitals in England.

Design Difference-in-differences analysis (using a control group created from trusts in England and providers in Scotland not implementing payment by results in the relevant years); retrospective analysis of patient level secondary data with fixed effects models.

Data sources English hospital episode statistics and Scottish morbidity records for 2002/3 to 2005/6.

Main outcome measures Changes in length of stay and proportion of day case admissions as a proxy for unit cost; growth in number of spells to measure increases in output; and changes in in-hospital mortality, 30 day post-surgical mortality, and emergency readmission after treatment for hip fracture as measures of impact on quality of care.

Results Length of stay fell more quickly and the proportion of day cases increased more quickly where payment by results was implemented, suggesting a reduction in the unit costs of care associated with payment by results. Some evidence of an association between the introduction of payment by results and growth in acute hospital activity was found. Little measurable change occurred in the quality of care indicators used in this study that can be attributed to the introduction of payment by results.

Conclusion Reductions in unit costs may have been achieved without detrimental impact on the quality of care, at least in as far as these are measured by the proxy variables used in this study.
Original languageEnglish
Article numberb3047
Number of pages8
JournalBritish Medical Journal
Volume339
DOIs
Publication statusPublished - 27 Aug 2009

Fingerprint

Quality of Health Care
Costs and Cost Analysis
Proxy
England
Length of Stay
Information Storage and Retrieval
Diagnosis-Related Groups
Hip Fractures
Scotland
Growth
Hospital Mortality
Emergencies
Outcome Assessment (Health Care)
Morbidity
Control Groups
Mortality
Therapeutics

Cite this

Has payment by results affected the way that English hospitals provide care? Difference-in-differences analysis. / Farrar, Shelley; Yi, Deokhee; Sutton, Matt; Chalkley, Martin; Sussex, Jon; Scott, Anthony .

In: British Medical Journal, Vol. 339, b3047, 27.08.2009.

Research output: Contribution to journalArticle

Farrar, Shelley ; Yi, Deokhee ; Sutton, Matt ; Chalkley, Martin ; Sussex, Jon ; Scott, Anthony . / Has payment by results affected the way that English hospitals provide care? Difference-in-differences analysis. In: British Medical Journal. 2009 ; Vol. 339.
@article{4a5edd8b02f3495c8b70cf97314a1bce,
title = "Has payment by results affected the way that English hospitals provide care?: Difference-in-differences analysis",
abstract = "Objective To examine whether the introduction of payment by results (a fixed tariff case mix based payment system) was associated with changes in key outcome variables measuring volume, cost, and quality of care between 2003/4 and 2005/6.Setting Acute care hospitals in England.Design Difference-in-differences analysis (using a control group created from trusts in England and providers in Scotland not implementing payment by results in the relevant years); retrospective analysis of patient level secondary data with fixed effects models.Data sources English hospital episode statistics and Scottish morbidity records for 2002/3 to 2005/6.Main outcome measures Changes in length of stay and proportion of day case admissions as a proxy for unit cost; growth in number of spells to measure increases in output; and changes in in-hospital mortality, 30 day post-surgical mortality, and emergency readmission after treatment for hip fracture as measures of impact on quality of care.Results Length of stay fell more quickly and the proportion of day cases increased more quickly where payment by results was implemented, suggesting a reduction in the unit costs of care associated with payment by results. Some evidence of an association between the introduction of payment by results and growth in acute hospital activity was found. Little measurable change occurred in the quality of care indicators used in this study that can be attributed to the introduction of payment by results.Conclusion Reductions in unit costs may have been achieved without detrimental impact on the quality of care, at least in as far as these are measured by the proxy variables used in this study.",
author = "Shelley Farrar and Deokhee Yi and Matt Sutton and Martin Chalkley and Jon Sussex and Anthony Scott",
year = "2009",
month = "8",
day = "27",
doi = "10.1136/bmj.b3047",
language = "English",
volume = "339",
journal = "BMJ",
issn = "0959-8146",
publisher = "BMJ Publishing Group",

}

TY - JOUR

T1 - Has payment by results affected the way that English hospitals provide care?

T2 - Difference-in-differences analysis

AU - Farrar, Shelley

AU - Yi, Deokhee

AU - Sutton, Matt

AU - Chalkley, Martin

AU - Sussex, Jon

AU - Scott, Anthony

PY - 2009/8/27

Y1 - 2009/8/27

N2 - Objective To examine whether the introduction of payment by results (a fixed tariff case mix based payment system) was associated with changes in key outcome variables measuring volume, cost, and quality of care between 2003/4 and 2005/6.Setting Acute care hospitals in England.Design Difference-in-differences analysis (using a control group created from trusts in England and providers in Scotland not implementing payment by results in the relevant years); retrospective analysis of patient level secondary data with fixed effects models.Data sources English hospital episode statistics and Scottish morbidity records for 2002/3 to 2005/6.Main outcome measures Changes in length of stay and proportion of day case admissions as a proxy for unit cost; growth in number of spells to measure increases in output; and changes in in-hospital mortality, 30 day post-surgical mortality, and emergency readmission after treatment for hip fracture as measures of impact on quality of care.Results Length of stay fell more quickly and the proportion of day cases increased more quickly where payment by results was implemented, suggesting a reduction in the unit costs of care associated with payment by results. Some evidence of an association between the introduction of payment by results and growth in acute hospital activity was found. Little measurable change occurred in the quality of care indicators used in this study that can be attributed to the introduction of payment by results.Conclusion Reductions in unit costs may have been achieved without detrimental impact on the quality of care, at least in as far as these are measured by the proxy variables used in this study.

AB - Objective To examine whether the introduction of payment by results (a fixed tariff case mix based payment system) was associated with changes in key outcome variables measuring volume, cost, and quality of care between 2003/4 and 2005/6.Setting Acute care hospitals in England.Design Difference-in-differences analysis (using a control group created from trusts in England and providers in Scotland not implementing payment by results in the relevant years); retrospective analysis of patient level secondary data with fixed effects models.Data sources English hospital episode statistics and Scottish morbidity records for 2002/3 to 2005/6.Main outcome measures Changes in length of stay and proportion of day case admissions as a proxy for unit cost; growth in number of spells to measure increases in output; and changes in in-hospital mortality, 30 day post-surgical mortality, and emergency readmission after treatment for hip fracture as measures of impact on quality of care.Results Length of stay fell more quickly and the proportion of day cases increased more quickly where payment by results was implemented, suggesting a reduction in the unit costs of care associated with payment by results. Some evidence of an association between the introduction of payment by results and growth in acute hospital activity was found. Little measurable change occurred in the quality of care indicators used in this study that can be attributed to the introduction of payment by results.Conclusion Reductions in unit costs may have been achieved without detrimental impact on the quality of care, at least in as far as these are measured by the proxy variables used in this study.

U2 - 10.1136/bmj.b3047

DO - 10.1136/bmj.b3047

M3 - Article

VL - 339

JO - BMJ

JF - BMJ

SN - 0959-8146

M1 - b3047

ER -