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מועדון חוקרים - ינואר 2018

 

בחינת המעבר של תשלום עבור שירותי האשפוז "מיום אשפוז" לפעולות דיפרנציאליות על פעילות הרופאים ובתי החולים

מציגה:

רות וייצברג  - מאיירס-ג'וינט-מכון ברוקדייל

מוזמנים לדיון:

דן גרינברג  - אוניברסיטת בן גוריון

בועז אריכא - משרד הבריאות





לצפיה במצגת

תקציר 

Effects of the recent adoption of activity-based hospital payment in Israel: an
evaluation of changes in hospital activities

Ruth Waitzberg1,2,3, Elad Daniels1, Vadim Perman4, Shuli Brammli-Greenberg1,5, Wilm Quentin3, Reinhard Busse3, Dan Greenberg2

 

Background: In 2010, Israel intensified the replacement of traditional per-diem (PD) payments to public hospitals with a local version of Diagnosis-Related Group like payments, i.e., procedure-related group (PRG) payments. PRG payments were created for certain procedures in medical fields such as urology, orthopedics, ophthalmology and general surgery. Non-procedural hospitalizations and certain procedures continued to be paid by PD.


Objectives: We investigated the impact of this PRG reform on hospitals' inpatient activities measured by the annually number of discharges and average length of stay (ALoS) at the ward level.

 

Methods: We used differences-in-differences analyses with two sets of controls: procedural wards as intervention and medical wards as controls; and among procedural wards, those for which PRG codes were created as intervention, and else as controls.


Results: Discharges increased and ALoS decreased in procedural wards compared to medical wards. However, the impact was, in fact, greater in non-PRG procedural wards, and differences-in-differences results indicated that the effect of the PRG reform on hospitals' inpatient activity was limited.


Discussion: Possibly, a concomitant shift of PRG-paid procedures to outpatient settings, encouraged by the MoH, limited the effect of the PRG reform in PRG-wards. Other factors that may have hampered the effects of the adoption of PRGs are inadequate pricing, conflicting incentives created by other co-existing hospital payment components, and the lack of resources to increase productivity or to enhance efficiency.

 

Conclusion and recommendations for policymakers: Despite important data limitations, the possible blurred effect of the reform on inpatient volumes and ALoS is an interesting finding that has implications for both researchers and policy-makers, also in other countries: The effect of payment reforms depends on various factors, including the national hospital market and its resources, the adequacy of costing and pricing, and co-existing payment components.

 

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[1] The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute.

[2] Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev.

[3] Department of Health Care Management, Faculty Economics & Management, Technical University Berlin, Germany.

[4] Planning, Budgeting and Pricing division, Ministry of Health.

[5] School of Public Health, University of Haifa.

חזרה