Paying for efficiency: Incentivising same-day discharges in the English NHS

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, despit...

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Bibliographic Details
Published in:Journal of health economics 2019-12, Vol.68, p.102226-102226, Article 102226
Main Authors: Gaughan, James, Gutacker, Nils, Grašič, Katja, Kreif, Noemi, Siciliani, Luigi, Street, Andrew
Format: Article
Language:English
Subjects:
Activity based funding
Adolescent
Adult
Aged
Aged, 80 and over
Control methods
Cost analysis
DRGs
Efficiency, Organizational - economics
England
Female
Health economics
Health services
Hospital incentives
Hospitals
Humans
Male
Middle Aged
Patient Discharge - economics
Pay for performance
Policy evaluation
Prospective payment systems
Reimbursement, Incentive
State Medicine
Statistical analysis
Synthetic control method
Young Adult
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Summary: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.
ISSN:0167-6296
1879-1646
DOI:10.1016/j.jhealeco.2019.102226