Do prospective payment systems (PPSs) lead to desirable providers’ incentives and patients’ outcomes? A systematic review of evidence from developing countries

Abstract

The reform of provider payment systems, from retrospective to prospective payment, has been heralded as the right move to contain costs in the light of rising health expenditures in many countries. However, there are concerns on quality trade-off. The heightened attention given to prospective payment system (PPS) reforms and the rise of empirical evidence regarding PPS interventions among developing countries suggest that a systematic review is necessary to understand the effects of PPS reforms in developing countries. A systematic search of 14 databases and a hand search of health policy journals and grey literature from October to November 2016 were carried out, guided by a set of inclusion and exclusion criteria. Data were extracted based on the Consolidated Health Economics Evaluation Reporting Standards checklist. Drummond's 10-item checklist for economic evaluation, Cochrane Collaboration's tool in assessing risk of bias for randomized trials, and Risk of Bias in Non-randomized Studies of Interventions were used to critically appraise the evidence. A total of 12 studies reported in China, Thailand and Vietnam were included in this review. Substantial heterogeneity was present in PPS policy design across different localities. PPS interventions were found to have reduced health expenditures on both the supply and demand side, as well as length of stay and readmission rates. In addition, PPS generally improved service quality outcomes by reducing the likelihood or percentage of physicians prescribing unnecessary drugs and diagnostic procedures. PPS is a promising policy tool for middle-income countries to achieve reasonable health policy objectives in terms of cost containment without necessarily compromising the quality of care. More evaluations of PPS will need to be conducted in the future in order to broaden the evidence base beyond middle-income countries.

The impact of provider payment reforms and associated care delivery models on cost and quality in cancer care: A systematic literature review

“…The findings of this study also suggest promising cost savings from transition to prospective reimbursement models, in which financial risks and accountability are redistributed towards providers in cancer care; these results are consistent with such findings in non-cancer settings [6,[9][10][11]. Although there is lack of evidence on whether quality of care was compromised in alternative payment models, resource use improvements were somewhat evident in per-diem payment, pay for performance, episode-based reimbursement, and Medicare Modernization Act reforms.…”

“…This transition is tied to care coordination and service delivery models to establish the components of a value-based system. Therefore, a wholesale change in practice is expected to take place while adapting performance metrics, operation systems, and legislative structures to provide value to patients [6,[9][10][11].…”

Unintended Impacts of the Global Budget on the Quality of Healthcare Among Inpatients with Heart Failure in China: An Explanatory Sequential Mixed-Methods Study

“…As literature shows, what occurred in this research (the relationship between GBP and medical quality) are essentially subjective. A purely quantitative approach is insu cient for us to adequately understand the changes in medical quality after the GBP reform [19].…”

“…Increasing household investments in health, decreasing health bene ts and surging healthcare costs have brought a huge challenge to healthcare reform in China and most countries in the world [1,2]. In order to cope with these challenges, the prepayment schemes represented by global budget payment (GBP), diagnosis-related groups (DRG) payment and capitation payment have gradually replaced the payment of fee-for-service as the mainstream payment method for medical insurance [3]. Similarly, China also has carried out a series of payment reforms to control the unreasonable increase in medical expenses [4].…”

“…Each step was based on quantitative data [9,13,16,17]. However, the factors affecting healthcare quality can hardly be generally described because of the complexity of medical market, the differences between countries and regions and the heterogeneity between institutions and patients [18,19]. Therefore, researchers are advised to give quantitative results in more details about background and personal experience (qualitative information) so as to better understand the internal mechanism and general rule of the impact of GBP on healthcare quality [20].…”