The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem, Israel.
Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
Isr J Health Policy Res. 2022 Feb 15;11(1):8. doi: 10.1186/s13584-022-00515-y.
In 2013-2014, Israel accelerated adoption of activity-based payments to hospitals. While the effects of such payments on patient length of stay (LoS) have been examined in several countries, there have been few analyses of incentive effects in the Israeli context of capped reimbursements and stretched resources.
We examined administrative data from the Israel Ministry of Health for 14 procedures from 2005 to 2016 in all not-for-profit hospitals (97% of the acute care beds). Survival analyses using a Weibull distribution allowed us to examine the non-negative and right-skewed data. We opted for a Bayesian approach to estimate relative change in LoS.
LoS declined in 7 of 14 procedures analyzed, notably, in 6 out of 7 urological procedures. In these procedures, reduction in LoS ranged between 11% and 20%. The estimation results for the control variables are mixed and do not indicate a clear pattern of association with LoS.
The decrease in LoS freed resources to treat other patients, which may have resulted in reduced waiting times. It may have been more feasible to reduce LoS for urological procedures since these had relatively long LoS. Policymakers should pay attention to the effects of decreases in LoS on quality of care. Stretched hospital resources, capped reimbursements, retrospective subsidies and underpriced procedures may have limited hospitals' ability to reduce LoS for other procedures where no decrease occurred (e.g., general surgery).
2013-2014 年，以色列加快了向医院提供基于活动的支付方式。尽管在几个国家已经对这种支付方式对患者住院时间（LoS）的影响进行了研究，但在以色列有上限报销和资源紧张的情况下，对激励效应的分析却很少。
我们使用 2005 年至 2016 年以色列卫生部的所有非营利性医院（占急性病床的 97%）的 14 项程序的行政数据进行了研究。使用威布尔分布的生存分析允许我们检查非负和右偏数据。我们选择贝叶斯方法来估计 LoS 的相对变化。
LoS 在 14 项分析的 7 项中下降，特别是在 7 项泌尿科手术中的 6 项中下降。在这些手术中，LoS 减少了 11%至 20%。控制变量的估计结果不一致，没有表明与 LoS 有明显的关联模式。
LoS 的降低释放了治疗其他患者的资源，这可能导致等待时间缩短。减少泌尿科手术的 LoS 可能更可行，因为这些手术的 LoS 相对较长。政策制定者应该注意减少 LoS 对护理质量的影响。医院资源紧张、报销上限、回溯性补贴和定价过低的程序可能限制了医院减少其他没有减少 LoS 的手术的能力（例如，普通外科手术）。
