Reimbursement systems and quality of hospital care: An empirical analysis for Italy

Abstract

There is an ongoing debate about the effect of different reimbursement systems on hospital performance and quality of care. The present paper aims at contributing to this literature by analysing the impact of different hospital payment schemes on patients' outcomes in Italy. The Italian National Health Service is, indeed, a particularly interesting case since it has been subject to a considerable decentralization process with wider responsibilities devolved to regional governments. Therefore, great variability exists in the way tariffs are used, as Regions have settled them in accordance with the characteristics of health care providers. An empirical analysis of the Italian hospital system is carried out using data from the National Program for Outcome Assessment on mortality and readmissions for Acute Myocardial Infarction (AMI), Congestive Heart Failure (CHF), stroke and Chronic Obstructive Pulmonary Diseases (COPD) in the years 2009-2010. The results show that hospitals operating in Regions where prospective payments are used more extensively are generally associated with better quality of care.

Frequency of Pregnancy Related Cancer

“…These forms contain information about patients and their hospitalization (both ordinary and in day hospital), including, among others, the unique anonymous patient's identification code, demographic characteristics, admission and discharge dates, the main diagnosis and 5 secondary diagnoses [coded according to the International Classification of Disease, Ninth Revision (ICD<9)], date and type of up to 5 interventions, and hospitalization<related costs [coded according to the national diagnosis<related group (DRG) system]. 7 Pregnancies were identified by selecting all SDOs reporting DRG codes related to both deliveries (DRG codes: 370Y375) and abortions (DRG codes: 380Y381). We further verified that each selected SDO reported diagnoses or interventions related to delivery or abortion.…”

The political economy of diagnosis-related groups

“…The Italian government released the first DRG tariffs list with Legislative Decree 169/1994, and since January 1995, all hospitals have been funded through a DRG-based system, which is enforced for every patient (Cavalieri et al, 2013). 5 National tariffs were calculated based on data gathered from eight hospitals located in the Northern and Central regions without differentiating among hospital types (Fattore, 2006).…”

Does the Extent of Per-Case Payment System Affect Hospital Efficiency? Evidence from the Italian NHS

“…The expected incentives for hospitals to save on costs under PPS have caused many concerns about possible reductions in the quality of care, although the current evidence in the literature suggests that introducing PPS does not significantly deteriorate quality (Coulam and Gaumer 1991;Cavalieri, Gitto and Guccio 2013;Cappellari, Paoli and Turati 2014).…”