Differential Effects of Declining Rates in a Per Diem Payment System

Besstremyannaya, Galina

doi:10.1002/hec.3128

Cited by 6 publications

(8 citation statements)

References 57 publications

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“…Fourth, our results may not be generalizable to conditions with short or very long average LOS. Other studies suggest that financial incentives may have differential effects on discharge behaviour over LOS [8,16]. However, as we provide evidence on marginal reimbursement incentives manifesting at an LOS of 10-22, depending on the cost group, we are only able to draw conclusions about this treatment duration.…”

Section: Discussionmentioning

confidence: 55%

“…days 10-22, depending on the cost group (see Table 1), of the LOS distribution. Evidence suggests that financial incentives may have a differential effect over LOS [8,16]. Furthermore, Pletscher [17] investigated a mixed reimbursement system consisting of per diem rates and case payment depending on the timing of discharge, which might lead to stronger financial incentives compared to solely declining per diem reimbursement.…”

Section: Discussionmentioning

confidence: 99%

“…As per diem payments have fewer incentives for cost containment [15], declining rates of payment may be used to disincentivize excessively long hospital stays [16]. If per diem rates, i.e.…”

Section: Introductionmentioning

confidence: 99%

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Do discontinuities in marginal reimbursement affect inpatient psychiatric care in Germany?

Pott¹,

Stargardt²,

Schneider

et al. 2020

Eur J Health Econ

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This paper examines the behaviour of mental health care providers in response to marginal payment incentives induced by a discontinuous per diem reimbursement schedule with varying tariff rates over the length of stay. The analyses use administrative data on 12,627 cases treated in 82 psychiatric hospitals and wards in Germany. We investigate whether substantial reductions in marginal reimbursement per inpatient day led to strategic discharge behaviour once a certain length of stay threshold is exceeded. The data do not show gaps and bunches at the duration of treatment when marginal reimbursement decreases. Using logistic regression models, we find that providers did not react to discontinuities in marginal reimbursement by significantly reducing inpatient length of stay around the threshold. These findings are robust in terms of different model specifications and subsamples. The results indicate that if regulators aim to set incentives to decrease LOS, this might not be achieved by cuts in reimbursement over LOS.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

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Do discontinuities in marginal reimbursement affect inpatient psychiatric care in Germany?

Pott¹,

Stargardt²,

Schneider

et al. 2020

Eur J Health Econ

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“…These reductions in inpatient LOS across health systems have been a result of a number of different factors. Within acute hospitals, greater use of more efficient surgery (Downing et al, 2009;Jayne et al, 2010;Laudicella et al, 2016), better discharge planning (Dedhia et al, 2009;Siegler et al, 2013), increasing use of palliative care planning (Brody et al, 2010), reductions in delayed discharges (McCoy et al, 2007;Rae et al, 2007) and more efficient payment mechanisms (Besstremyannaya, 2016;Borghans et al, 2008;Échevin and Fortin, 2014;Farrar et al, 2009) have been shown to reduce LOS. For specific patient populations, focused care units such as early supported discharge units and stroke units (Confalonieri et al, 2015;Keegan and Smith, 2013) and greater provision of non-acute follow-up and rehabilitation care have also been shown to allow patients to be discharged more quickly to potentially more appropriate care settings (Dahl et al, 2015;Gozalo et al, 2015;McCoy et al, 2007;Neiterman et al, 2015;Wren et al, 2014).…”

Section: Acute Capacity and Length Of Staymentioning

confidence: 99%

An analysis of the effects on Irish hospital care of the supply of care inside and outside the hospital

Walsh¹,

Wren²,

Smith³

et al. 2019

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The mission of the Economic and Social Research Institute is to advance evidencebased policymaking that supports economic sustainability and social progress in Ireland. ESRI researchers apply the highest standards of academic excellence to challenges facing policymakers, focusing on 12 areas of critical importance to 21st Century Ireland.The Institute was founded in 1960 by a group of senior civil servants led by Dr T.K. Whitaker, who identified the need for independent and in-depth research analysis to provide a robust evidence base for policymaking in Ireland.Since then, the Institute has remained committed to independent research and its work is free of any expressed ideology or political position. The Institute publishes all research reaching the appropriate academic standard, irrespective of its findings or who funds the research.The quality of its research output is guaranteed by a rigorous peer review process. ESRI researchers are experts in their fields and are committed to producing work that meets the highest academic standards and practices.The work of the Institute is disseminated widely in books, journal articles and reports. ESRI publications are available to download, free of charge, from its website. Additionally, ESRI staff communicates research findings at regular conferences and seminars.The ESRI is a company limited by guarantee, answerable to its members and governed by a Council, comprising 14 members who represent a cross-section of ESRI members from academia, civil services, state agencies, businesses and civil society. The Institute receives an annual grant-in-aid from the Department of Public Expenditure and Reform to support the scientific and public interest elements of the Institute's activities; the grant accounted for an average of 30 per cent of the Institute's income over the lifetime of the last Research Strategy. The remaining funding comes from research programmes supported by government departments and agencies, public bodies and competitive research programmes.

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“…These reductions in inpatient length of stay are due to several factors. Within hospitals, greater use of more efficient surgery [ 2 – 4 ], better discharge planning [ 5 , 6 ], palliative care planning [ 7 ], reductions in delayed discharges [ 8 , 9 ], and more efficient payment mechanisms [ 10 – 13 ] have been shown to reduce length of stay. For specific patient populations, focused care units, such as for early supported discharge units and stroke units [ 14 , 15 ], and greater provision of non-acute follow-up and rehabilitation care [ 8 , 16 – 18 ] has allowed patients to be discharged more quickly.…”

Section: Introductionmentioning

confidence: 99%

The impact of inpatient bed capacity on length of stay

et al. 2021

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Objective Large reductions in inpatient length of stay and inpatient bed supply have occurred across health systems in recent years. However, the direction of causation between length of stay and bed supply is often overlooked. This study examines the impact of changes to inpatient bed supply, as a result of recession-induced healthcare expenditure changes, on emergency inpatient length of stay in Ireland between 2010 and 2015. Study design We analyse all public hospital emergency inpatient discharges in Ireland from 2010 to 2015 using the administrative Hospital In-Patient Enquiry dataset. We use changes to inpatient bed supply across hospitals over time to examine the impact of bed supply on length of stay. Linear, negative binomial, and hospital–month-level fixed effects models are estimated. Results U-shaped trends are observed for both average length of stay and inpatient bed supply between 2010 and 2015. A consistently large positive relationship is found between bed supply and length of stay across all regression analyses. Between 2010 and 2012 while length of stay fell by 6.4%, our analyses estimate that approximately 42% (2.7% points) of this reduction was associated with declines in bed supply. Conclusion Changes in emergency inpatient length of stay in Ireland between 2010 and 2015 were closely related to changes in bed supply during those years. The use of length of stay as an efficiency measure should be understood in the contextual basis of other health system changes. Lower length of stay may be indicative of the lack of resources or available bed supply as opposed to reduced demand for care or the shifting of care to other settings.

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Differential Effects of Declining Rates in a Per Diem Payment System

Cited by 6 publications

References 57 publications

Do discontinuities in marginal reimbursement affect inpatient psychiatric care in Germany?

Do discontinuities in marginal reimbursement affect inpatient psychiatric care in Germany?

An analysis of the effects on Irish hospital care of the supply of care inside and outside the hospital

The impact of inpatient bed capacity on length of stay

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