System-Wide Impacts of Hospital Payment Reforms: Evidence from Central and Eastern Europe and Central Asia

While there is broad agreement that the way that health care providers are paid affects their performance, the empirical literature on the impacts of provider payment reforms is surprisingly thin. During the 1990s and early 2000s, many European and Central Asian (ECA) countries shifted from paying h...

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Main Authors:	Moreno-Serra, Rodrigo, Wagstaff, Adam
Format:	Journal Article
Language:	EN
Published:	2012
Subjects:	National Government Expenditures and Health H510 Analysis of Health Care Markets I110 Health Production I120
Online Access:	http://hdl.handle.net/10986/4785

id	okr-10986-4785
recordtype	oai_dc
spelling	okr-10986-47852021-04-23T14:02:19Z System-Wide Impacts of Hospital Payment Reforms: Evidence from Central and Eastern Europe and Central Asia Moreno-Serra, Rodrigo Wagstaff, Adam National Government Expenditures and Health H510 Analysis of Health Care Markets I110 Health Production I120 While there is broad agreement that the way that health care providers are paid affects their performance, the empirical literature on the impacts of provider payment reforms is surprisingly thin. During the 1990s and early 2000s, many European and Central Asian (ECA) countries shifted from paying hospitals through historical budgets to fee-for-service (FFS) or patient-based payment (PBP) methods (mostly variants of diagnosis-related groups, or DRGs). Using panel data on 28 countries over the period 1990-2004, we exploit the phased shift from historical budgets to explore aggregate impacts on hospital throughput, national health spending, and mortality from causes amenable to medical care. We use a regression version of difference-in-differences (DID) and two variants that relax the DID parallel trends assumption. We find that FFS and PBP both increased national health spending, including private (i.e. out-of-pocket) spending. However, they had different effects on inpatient admissions (FFS increased them; PBP had no effect), and average length of stay (FFS had no effect; PBP reduced it). Of the two methods, only PBP appears to have had any beneficial effect on "amenable mortality", but we found significant impacts for only a couple of causes of death, and not in all model specifications. 2012-03-30T07:29:44Z 2012-03-30T07:29:44Z 2010 Journal Article Journal of Health Economics 01676296 http://hdl.handle.net/10986/4785 EN http://creativecommons.org/licenses/by-nc-nd/3.0/igo World Bank Journal Article Central Asia Central Europe Eastern Europe
repository_type	Digital Repository
institution_category	Foreign Institution
institution	Digital Repositories
building	World Bank Open Knowledge Repository
collection	World Bank
language	EN
topic	National Government Expenditures and Health H510 Analysis of Health Care Markets I110 Health Production I120
spellingShingle	National Government Expenditures and Health H510 Analysis of Health Care Markets I110 Health Production I120 Moreno-Serra, Rodrigo Wagstaff, Adam System-Wide Impacts of Hospital Payment Reforms: Evidence from Central and Eastern Europe and Central Asia
geographic_facet	Central Asia Central Europe Eastern Europe
relation	http://creativecommons.org/licenses/by-nc-nd/3.0/igo
description	While there is broad agreement that the way that health care providers are paid affects their performance, the empirical literature on the impacts of provider payment reforms is surprisingly thin. During the 1990s and early 2000s, many European and Central Asian (ECA) countries shifted from paying hospitals through historical budgets to fee-for-service (FFS) or patient-based payment (PBP) methods (mostly variants of diagnosis-related groups, or DRGs). Using panel data on 28 countries over the period 1990-2004, we exploit the phased shift from historical budgets to explore aggregate impacts on hospital throughput, national health spending, and mortality from causes amenable to medical care. We use a regression version of difference-in-differences (DID) and two variants that relax the DID parallel trends assumption. We find that FFS and PBP both increased national health spending, including private (i.e. out-of-pocket) spending. However, they had different effects on inpatient admissions (FFS increased them; PBP had no effect), and average length of stay (FFS had no effect; PBP reduced it). Of the two methods, only PBP appears to have had any beneficial effect on "amenable mortality", but we found significant impacts for only a couple of causes of death, and not in all model specifications.
format	Journal Article
author	Moreno-Serra, Rodrigo Wagstaff, Adam
author_facet	Moreno-Serra, Rodrigo Wagstaff, Adam
author_sort	Moreno-Serra, Rodrigo
title	System-Wide Impacts of Hospital Payment Reforms: Evidence from Central and Eastern Europe and Central Asia
title_short	System-Wide Impacts of Hospital Payment Reforms: Evidence from Central and Eastern Europe and Central Asia
title_full	System-Wide Impacts of Hospital Payment Reforms: Evidence from Central and Eastern Europe and Central Asia
title_fullStr	System-Wide Impacts of Hospital Payment Reforms: Evidence from Central and Eastern Europe and Central Asia
title_full_unstemmed	System-Wide Impacts of Hospital Payment Reforms: Evidence from Central and Eastern Europe and Central Asia
title_sort	system-wide impacts of hospital payment reforms: evidence from central and eastern europe and central asia
publishDate	2012
url	http://hdl.handle.net/10986/4785
_version_	1764392748160385024

System-Wide Impacts of Hospital Payment Reforms: Evidence from Central and Eastern Europe and Central Asia

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