Centre for Health Economics, University of York, United Kingdom.
Centre for Health Economics, University of York, United Kingdom.
J Health Econ. 2019 Dec;68:102226. doi: 10.1016/j.jhealeco.2019.102226. Epub 2019 Aug 21.
We study a pay-for-efficiency scheme that encourages hospitals to admit and discharge patients on the same calendar day when clinically appropriate. Since 2010, hospitals in the English NHS are incentivised by a higher price for patients treated as same-day discharge than for overnight stays, despite the former being less costly. We analyse administrative data for patients treated during 2006-2014 for 191 conditions for which same-day discharge is clinically appropriate - of which 32 are incentivised. Using difference-in-difference and synthetic control methods, we find that the policy had generally a positive impact with a statistically significant effect in 14 out of the 32 conditions. The median elasticity is 0.24 for planned and 0.01 for emergency conditions. Condition-specific design features explain some, but not all, of the differential responses.
我们研究了一种按效付费的方案，鼓励医院在临床适宜的情况下，对患者进行同日入院和出院。自 2010 年以来，英国国民保健署（NHS）的医院对符合当日出院条件的患者收取更高的费用，而不是过夜费用，尽管前者的成本更低。我们分析了 2006 年至 2014 年间 191 种适合当日出院的疾病的患者的管理数据，其中 32 种疾病有激励措施。我们使用差分和合成控制方法发现，该政策总体上具有积极影响，在 32 种疾病中有 14 种具有统计学意义。计划内疾病的中位弹性为 0.24，急诊疾病为 0.01。疾病特定的设计特征解释了部分而非全部的差异反应。
