It probably worked: a Bayesian approach to evaluating the introduction of activity-based hospital payment in Israel

Abstract

Background In 2013–2014, Israel accelerated adoption of activity-based payments to hospitals. While the effects of such payments on patient length of stay (LoS) have been examined in several countries, there have been few analyses of incentive effects in the Israeli context of capped reimbursements and stretched resources. Methods We examined administrative data from the Israel Ministry of Health for 14 procedures from 2005 to 2016 in all not-for-profit hospitals (97% of the acute care beds). Survival analyses using a Weibull distribution allowed us to examine the non-negative and right-skewed data. We opted for a Bayesian approach to estimate relative change in LoS. Results LoS declined in 7 of 14 procedures analyzed, notably, in 6 out of 7 urological procedures. In these procedures, reduction in LoS ranged between 11% and 20%. The estimation results for the control variables are mixed and do not indicate a clear pattern of association with LoS. Conclusions The decrease in LoS freed resources to treat other patients, which may have resulted in reduced waiting times. It may have been more feasible to reduce LoS for urological procedures since these had relatively long LoS. Policymakers should pay attention to the effects of decreases in LoS on quality of care. Stretched hospital resources, capped reimbursements, retrospective subsidies and underpriced procedures may have limited hospitals' ability to reduce LoS for other procedures where no decrease occurred (e.g., general surgery).

Differences in Treatment Patterns and Outcomes of Acute Myocardial Infarction for Low- and High-Income Patients in 6 Countries

“…We developed the International Health System Research Collaborative (IHSRC) to facilitate population-level comparisons of treatment patterns and outcomes in the US, Canada, England, the Netherlands, Israel, and Taiwan; countries with highly developed health care systems and accessible administrative data but that have significant differences in financing, organization, and performance in international rankings . In this study, we compare differences in acute myocardial infarction (MI) treatment (eg, cardiac catheterization, revascularization) and outcomes (mortality, readmissions) for high- and low-income patients across 6 countries.…”

Exploratory Study on the Compensation Practices in Private Hospitals for Clinical Specialists in Malaysia

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Using the Elixhauser Risk Adjustment Model to Predict Outcomes Among Patients Hospitalized in Internal Medicine at a Large, Tertiary-Care Hospital in Israel

“…This puts extra strain on IM wards, which may not be present on more procedure-oriented services, whose reimbursement is more straightforward and more re ective of the actual amount of work involved in caring for such a patient. In Israel, there are three types of reimbursement for admitted patients: per diem (e.g., medical patients), per procedure (e.g., surgical patients) or fee-for-service [28,29]. The IM patients can be complex, but it is well-known that there are not enough ward beds in Israel to accommodate all the patients requiring an IM bed -especially in the winter, when respiratory viruses increase the number of hospitalizations to IM services [27].…”