The Impact Of Bundled Payment On Health Care Spending, Utilization, And Quality: A Systematic Review

Agarwal, Rajender; Liao, Joshua M.; Gupta, Ashutosh; Navathe, Amol S.

doi:10.1377/hlthaff.2019.00784

Cited by 131 publications

(116 citation statements)

References 28 publications

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“…Disease phenomenon [21][22][23][24].In addition, DRGs also has some practices in China, but we think it is not suitable for China's county-level regions, especially the central and western regions where the economy and medical care are underdeveloped.Relatively speaking, the current stage of medical insurance informatization in these areas and the standardization of hospital information systems are uneven, which leads to inadequate supervision and brings di culties to the collection of large amounts of data required for DRGs coding.Second, after the implementation of DRGs, doctors may increase their income by over-diagnosing and changing the level of surgery, and cannot really save medical insurance funds; when facing the same price, patients are more likely to prefer county-level hospitals with better medical conditions. Nor can it change the current contradiction between countylevel hospitals and primary health service centers, which runs counter to the reform goals;The total prepaid execution cost is low, and it can effectively control the medical cost, but its disadvantage is that it is di cult to ensure the quality of medical treatment and may cause medical institutions to reject patients [25][26][27][28].The performance-based payment method is usually implemented together with other payment methods. The purpose is to control costs while ensuring the quality of medical services.…”

Section: Comparison With Other Medical Insurance Payment Methodsmentioning

confidence: 99%

The Impact of China's Total Medical Insurance Package Payment Based on Compact County Medical Community and Its Implications for Medical Insurance Funds: Evidence from Y County, China

Liu¹,

Yang

et al. 2020

Preprint

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Background:Due to the irrational structure of medical and health resources, uneven distribution, and low level of grassroots services, traditional medical insurance payment methods in China’s underdeveloped areas have not been fully utilized in regulating medical service behaviors and guiding the allocation of medical resources. The medical insurance fund of many regions collapsed, the fund balance rate and compensation rate decreased year by year, and the medical expenses rose rapidly, which seriously affected the enthusiasm of the insured residents. As a results,the sustainable development of the medical insurance fund faced many difficulties and challenges.Based on this, we want to design a medical insurance policy suitable for underdeveloped areas in China to improve the capacity and efficiency of health services and maintain the stability of medical insurance funds.Methods:Collected medical insurance data of Y County in China from 2018 to 2019.The interruption time series(ITS) was used to evaluate the utilization of medical insurance funds in county-level hospitals, primary health service centers, and hospitals outside the medical community.Results:Inpatient expenditure(IE) per capita,out-of-pocket inpatient expenditure(OIE) per capita,and medical insurance expenditure (MIE)per capita in county-level hospitals increased by 84.682, 6.564 and 62.302 yuan per month respectively after the reform; Number of annul discharges persons(NOADP)from basic health service centers increased by 36.899 per month after the reform; IE per capita and MIE per capita increased by 18.624 yuan and 15.767 yuan per month on average after the reform; the residents hospitalized outside CCMC decreased by 9.545 per month on average after the reform. Conclusions:China should further implement the CCMC-based TMIPPM reform to control medical expenses and maintain the stability of medical insurance funds in in more trials.

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Section: Comparison With Other Medical Insurance Payment Methodsmentioning

confidence: 99%

The Impact of China's Total Medical Insurance Package Payment Based on Compact County Medical Community and Its Implications for Medical Insurance Funds: Evidence from Y County, China

Liu¹,

Yang

et al. 2020

Preprint

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“…Forløpsbaserte finansieringsordninger for andre prosedyrer har gått i økonomisk balanse uten at kvaliteten forringes. Dette gjelder blant annet rygginngrep og koronare bypassoperasjoner (12).…”

Section: Prissetting Og Designunclassified

En introduksjon til forløpsbasert finansiering

Mjåset¹,

Byrkjeflot²,

Hanssen³

et al. 2020

Tidsskriftet

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Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. HALDOR BYRKJEFLOT Haldor Byrkjeflot er professor ved Institutt for sosiologi og samfunnsgeografi ved Universitetet i Oslo og gjesteforsker ved Weatherhead Center for International Affairs, Harvard University. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. FREDRIK A.S.R. HANSSEN Fredrik A.S.R. Hanssen er avdelingsdirektør i Helsedirektoratets avdeling for finansiering. Han er lege med klinisk bakgrunn i indremedisin og har arbeidet med klassifisering, aktivitetsmåling og finansiering av helsetjenester. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. WILLIAM WYNN-JONES William Wynn-Jones er britisk anestesiolog og helsetjenesteforsker tilknyttet Center for Surgery and Public Health ved Brigham and Women's Hospital i Boston, der han også var Harkness fellow i 2017-18. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter.

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“…CMS's bundled payment program for joint replacement reduced Medicare spending by 1.6 percent from 2013-2016, while still maintaining or improving quality of care. 38,39 However, bundled payments for other clinical episodes such as spinal fusion surgery or heart failure have not shown evidence of reduced spending or quality improvement. 39 In addition, a bundled payment does not guarantee that the patient actually needs to undergo the procedure.…”

Section: Solutionsmentioning

confidence: 99%

“…38,39 However, bundled payments for other clinical episodes such as spinal fusion surgery or heart failure have not shown evidence of reduced spending or quality improvement. 39 In addition, a bundled payment does not guarantee that the patient actually needs to undergo the procedure. Theoretically, "global budgeting," or paying a hospital a set amount per year to care for a defined population of patients could provide an incentive for hospitals to reduce the delivery of unnecessary services, which would reduce costs.…”

Section: Solutionsmentioning

confidence: 99%

White paper: Overuse in U.S. hospitals

Garber¹,

Brownlee²,

Saini³

2020

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Overuse, which is also known as low-value care, is often defined as the provision of health care services for which the potential for harm exceeds the likely benefit to a patient. Overuse occurs in all healthcare settings, including hospitals. It exposes patients to preventable harm and wastes more than $100 billion each year. To date, no study has published the rate of overuse in specific U.S. hospitals. Maine, Minnesota, Montana, New Hampshire, Oregon, and Vermont all had average rankings above the 70th percentile. While we do not know for certain what drives differences in overuse among hospitals, previous research suggests that hospital capacity and resources, hospital competition, and individual hospital culture are all associated with overuse. 1,2 These factors point to potential policy solutions for reducing hospital overuse, such as new payment models, educational initiatives, and more effective oversight of hospitals' capital investments.

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The Impact Of Bundled Payment On Health Care Spending, Utilization, And Quality: A Systematic Review

Cited by 131 publications

References 28 publications

The Impact of China's Total Medical Insurance Package Payment Based on Compact County Medical Community and Its Implications for Medical Insurance Funds: Evidence from Y County, China

The Impact of China's Total Medical Insurance Package Payment Based on Compact County Medical Community and Its Implications for Medical Insurance Funds: Evidence from Y County, China

En introduksjon til forløpsbasert finansiering

White paper: Overuse in U.S. hospitals

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