System-Wide Impacts of Hospital Payment Reforms : Evidence from Central and Eastern Europe and Central Asia

Moreno-Serra, Rodrigo; Wagstaff, Adam

dc.creator	Moreno-Serra, Rodrigo
dc.creator	Wagstaff, Adam
dc.date	2012-03-19T19:11:29Z
dc.date	2012-03-19T19:11:29Z
dc.date	2009-07-01
dc.date.accessioned	2023-02-17T21:10:46Z
dc.date.available	2023-02-17T21:10:46Z
dc.identifier	http://www-wds.worldbank.org/external/default/main?menuPK=64187510&pagePK=64193027&piPK=64187937&theSitePK=523679&menuPK=64187510&searchMenuPK=64187283&siteName=WDS&entityID=000158349_20090715162549
dc.identifier	http://hdl.handle.net/10986/4186
dc.identifier.uri	http://localhost:8080/xmlui/handle/CUHPOERS/245223
dc.description	Although there is broad agreement that the way that health care providers are paid affects their performance, the empirical literature on the impacts of provider payment reforms is surprisingly thin. During the 1990s and early 2000s, many European and Central Asian countries shifted from paying hospitals through historical budgets to fee-for-service or patient-based-payment methods (mostly variants of diagnosis-related groups). Using panel data on 28 countries over the period 1990-2004, the authors of this study exploit the phased shift from historical budgets to explore aggregate impacts on hospital throughput, national health spending, and mortality from causes amenable to medical care. They use a regression version of difference-in-differences and two variants that relax the difference-in-differences parallel trends assumption. The results show that fee-for-service and patient-based-payment methods both increased national health spending, including private (out-of-pocket) spending. However, they had different effects on inpatient admissions (fee-for-service increased them; patient-based-payment had no effect), and average length of stay (fee-for-service had no effect; patient-based-payment reduced it). Of the two methods, only patient-based-payment appears to have had any beneficial effect on "amenable mortality," but there were significant impacts for only a couple of causes of death, and not in all model specifications.
dc.language	English
dc.relation	Impact Evaluation series ; no. IE 32 Policy Research working paper ; no. WPS 4987
dc.rights	CC BY 3.0 IGO
dc.rights	http://creativecommons.org/licenses/by/3.0/igo/
dc.rights	World Bank
dc.subject	ACCESS TO HEALTH CARE
dc.subject	ADMINISTRATIVE COSTS
dc.subject	AGED
dc.subject	AMBULATORY CARE
dc.subject	BEDS
dc.subject	BLOCK CONTRACTS
dc.subject	BLOCK GRANTS
dc.subject	BREAST CANCER
dc.subject	CAPITA HEALTH SPENDING
dc.subject	CAPITATION
dc.subject	CATASTROPHIC HEALTH SPENDING
dc.subject	CAUSES OF DEATH
dc.subject	CHOICE OF PROVIDER
dc.subject	CLINICAL PATHWAYS
dc.subject	COSTS OF HOSPITALS
dc.subject	DEATH RATE
dc.subject	DEATH RATES
dc.subject	DEATHS
dc.subject	DIABETES
dc.subject	DIAGNOSIS
dc.subject	DIAGNOSTIC TESTS
dc.subject	DIGESTIVE SYSTEM
dc.subject	DISCHARGE PATIENTS
dc.subject	DISEASES
dc.subject	DISSEMINATION
dc.subject	DRUGS
dc.subject	ECONOMIES OF SCALE
dc.subject	EXERCISES
dc.subject	FEE SCHEDULE
dc.subject	FEE-FOR-SERVICE
dc.subject	FEE-FOR-SERVICE ARRANGEMENTS
dc.subject	FEE-FOR-SERVICE METHODS
dc.subject	GLOBAL BUDGETS
dc.subject	HEALTH CARE
dc.subject	HEALTH CARE MANAGEMENT
dc.subject	HEALTH CARE PROVIDERS
dc.subject	HEALTH CARE SECTOR
dc.subject	HEALTH CARE SYSTEMS
dc.subject	HEALTH ECONOMICS
dc.subject	HEALTH EXPENDITURE
dc.subject	HEALTH EXPENDITURES
dc.subject	HEALTH FINANCING
dc.subject	HEALTH FINANCING MECHANISM
dc.subject	HEALTH FOR ALL
dc.subject	HEALTH INSURANCE
dc.subject	HEALTH INSURANCE COMPANIES
dc.subject	HEALTH INSURANCE FUND
dc.subject	HEALTH ORGANIZATION
dc.subject	HEALTH OUTCOMES
dc.subject	HEALTH PROFESSIONALS
dc.subject	HEALTH SECTOR
dc.subject	HEALTH SECTOR REFORM
dc.subject	HEALTH SERVICE
dc.subject	HEALTH STATUS
dc.subject	HEALTH SYSTEM
dc.subject	HEALTH SYSTEMS
dc.subject	HEALTH SYSTEMS IN TRANSITION
dc.subject	HOSPITAL
dc.subject	HOSPITAL ADMISSION
dc.subject	HOSPITAL ADMISSIONS
dc.subject	HOSPITAL BEDS
dc.subject	HOSPITAL CARE
dc.subject	HOSPITAL COSTS
dc.subject	HOSPITAL PATIENTS
dc.subject	HOSPITAL REVENUES
dc.subject	HOSPITAL SECTOR
dc.subject	HOSPITAL SPENDING
dc.subject	HOSPITALIZATION
dc.subject	HOSPITALS
dc.subject	HUMAN DEVELOPMENT
dc.subject	IMPACT ON HEALTH
dc.subject	INCOME
dc.subject	INFORMAL PAYMENTS
dc.subject	INPATIENT CARE
dc.subject	INSURANCE ARRANGEMENTS
dc.subject	INSURANCE COMPANIES
dc.subject	INSURANCE SYSTEMS
dc.subject	INSURERS
dc.subject	MARGINAL COST
dc.subject	MEDICAID
dc.subject	MEDICAL CARE
dc.subject	MEDICAL CONDITIONS
dc.subject	MEDICAL DOCTORS
dc.subject	MEDICAL PROCEDURES
dc.subject	MEDICARE
dc.subject	MINISTRIES OF HEALTH
dc.subject	MINORITY
dc.subject	MORTALITY
dc.subject	MORTALITY REDUCTIONS
dc.subject	NATIONAL HEALTH
dc.subject	NATIONAL HEALTH SPENDING
dc.subject	PATIENT
dc.subject	PATIENTS
dc.subject	PHYSICIANS
dc.subject	POCKET PAYMENTS
dc.subject	POLICY RESEARCH
dc.subject	POLICY RESEARCH WORKING PAPER
dc.subject	PREMATURE DEATH
dc.subject	PRIMARY CARE
dc.subject	PRIMARY CARE DOCTORS
dc.subject	PRIMARY CARE SECTOR
dc.subject	PRIMARY HEALTH CARE
dc.subject	PRIVATE HOSPITALS
dc.subject	PRIVATE SECTOR
dc.subject	PRIVATE SPENDING
dc.subject	PROVIDER PAYMENT
dc.subject	PUBLIC HEALTH
dc.subject	PUBLIC HEALTH EXPENDITURES
dc.subject	PUBLIC SERVICES
dc.subject	PUBLIC SPENDING
dc.subject	PURCHASER-PROVIDER SPLIT
dc.subject	PURCHASING POWER
dc.subject	PURCHASING POWER PARITY
dc.subject	QUALITY OF CARE
dc.subject	QUALITY OF LIFE
dc.subject	REIMBURSEMENT RATES
dc.subject	REIMBURSEMENT SYSTEMS
dc.subject	RESPECT
dc.subject	SCREENING
dc.subject	SOCIAL HEALTH INSURANCE
dc.subject	URBAN POPULATION
dc.subject	USE OF RESOURCES
dc.subject	VACCINATIONS
dc.subject	WAR
dc.subject	WORLD HEALTH ORGANIZATION
dc.title	System-Wide Impacts of Hospital Payment Reforms : Evidence from Central and Eastern Europe and Central Asia
dc.type	Publications & Research :: Policy Research Working Paper
dc.coverage	Europe and Central Asia
dc.coverage	Europe and Central Asia