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Hospital Payment Systems

  • Paolo BelliEmail author
  • Patrick Jeurissen
Chapter

Abstract

Payment systems (PS) are at the core of the intermediation function between payers and recipients of care, which is complex because of the lack of functioning true markets in healthcare, and where the final outcome is significantly disconnected from what is paid for. There is a major distinction between retrospective and prospective PS. Incentives vary in complex ways, and correspondingly with complex results, between line-item budgets, per diem, global budgets, capitation, diagnosis-related groups, fee-for-service, and pay-for-performance. There are often trade-offs between providing incentives for enhancing quality and containing costs, risk selection and efficiency, creating producer surplus and inducing supply, and governance control and flexibility. Quality top-ups look like a promising route in systems which are neither fully prospective nor retrospective, and which relate to the business model employed.

Keywords

Business model Capitation Diagnosis-related groups Efficiency Fee-for-service Flexibility Global budgets Governance Incentives Intermediation Line-item budgets Markets Pay-for-performance Payment systems Per diem Producer surplus Prospective Quality top-ups  Retrospective Risk selection Trade-offs 

References

  1. Allen, R., & Gertler, P. (1991). Regulation and the Provision of Quality to Heterogeneous Consumers: The Case of Prospective Pricing of Medical Services. Journal of Regulatory Economics, 3, 361–375.CrossRefGoogle Scholar
  2. Belli, P. (2002). Incentives and the Reform of Health Care Systems. London: London School of Economics, PhD thesis.Google Scholar
  3. Busse, R., Geissler, A., Aaviksoo, A., Cots, F., Hakkinen, U., Kobel, C., et al. (2013). Diagnosis Related Groups in Europe: Moving Towards Transparency, Efficiency, and Quality in Hospitals? BMJ (Clinical Research ed.), 347(7916), 1–7.Google Scholar
  4. Chalkley, M., & Malcomson, J. (1995). Contracting for Health Services with Unmonitored Quality. Discussion Papers in Economics and Econometrics 9510, University of Southampton.Google Scholar
  5. Chalkley, M., & Malcomson, J. (1998). Contracting for Health Services When Patient Demand Does Not Reflect Quality. Journal of Health Economics, 17, 1–20.CrossRefGoogle Scholar
  6. Chilingerian, J. (2008). Origins of DRGs in the United States: A Technical, Political and Cultural Story. In J. Kimberly, G. De Pouvourville, & T. D’Aunno (Eds.), The Globalization of Managerial Innovation in Health Care (pp. 4–33). Cambridge: Cambridge University Press. Retrieved from https://www.cambridge.org/core/books/globalization-of-managerial-innovation-in-health-care/origins-of-drgs-in-the-united-states-a-technical-political-and-cultural-story/708E309A8ED8C6C018C45C160356EABD.CrossRefGoogle Scholar
  7. Christensen, C. (2009). The Innovator’s Prescription a Disruptive Solution for Healthcare. New York: McGraw Hill.Google Scholar
  8. Dranove, D. (1988). Demand Inducement and the Physician/Patient Relationship. Economic Inquiry, 26(2), 281–298.CrossRefGoogle Scholar
  9. Ellis, R., & McGuire, T. (1986). Provider Behaviour Under Prospective’ Reimbursement. Journal of Health Economics, 5, 129–151.CrossRefGoogle Scholar
  10. Ellis, R., & McGuire, T. (1990). Optimal Payment Systems for Health Services. Journal of Health Economics, 9, 375–396.CrossRefGoogle Scholar
  11. Enthoven, A. (1985). Reflections of the Management of the NHS. London: Nuffield & Provincial Hospitals Trust.Google Scholar
  12. Evans, R. (1974). Supplier-Induced Demand: Some Empirical Evidence and Implications. In M. Perlman (Ed.), The Economics of Health and Medical Care. London: Macmillan.Google Scholar
  13. Fuchs, V. (1978). The Supply of Surgeons and the Demand for Operations. Journal of Human Resources, 13, 35–56.CrossRefGoogle Scholar
  14. Glazer, J., & McGuire, T. (1994). Payer Competition and Cost Shifting in Health Care. Journal of Economics and Management Strategy, 3, 71–92.CrossRefGoogle Scholar
  15. Hodgkin, D., & McGuire, T. (1994). Payment Levels and Hospital Response to Prospective Payment. Journal of Health Economics, 13, 1–29.CrossRefGoogle Scholar
  16. Holmstrom, B., & Milgrom, P. (1990). Multitask Principal-Agent Analyses: Incentive Contracts, Asset Ownership, and Job Design. Journal of Law, Economics, and Organization, 7, 24–52.CrossRefGoogle Scholar
  17. Ma, C. (1994). Health Care Payment Systems: Cost and Quality Incentives. Journal of Economics and Management Strategy, 3, 93–112.CrossRefGoogle Scholar
  18. Ma, C., & McGuire, T. (1997). Optimal Health Insurance and Provider Payment. American Economic Review, 87(4), 685–700.Google Scholar
  19. Mooney, G., & Ryan, M. (1993). Agency in Health Care: Getting Beyond First Principles. Journal of Health Economics, 12, 125–136.CrossRefGoogle Scholar
  20. Rice, N., & Smith, P. (2000). Strategic Resource Allocation and Funding Decisions. Copenhagen: European Observatory on Health Care Systems. Paper presented at the European Observatory on Health Care Systems’ Project on Funding Health Care: Options for Europe.Google Scholar
  21. Robinson, J. C., & Luft, H. S. (1985). The Impact of Hospital Market Structure on Patient Volume, Average Length of Stay, and the Cost of Care. Journal of Health Economics, 4(4), 333–356.CrossRefGoogle Scholar
  22. Roemer, M. (1961). Bed Supply and Hospital Utilization: A Natural Experiment. Hospitals, 35, 36–42.Google Scholar
  23. Rogerson, W. (1994). Choice of Treatment Intensities by a Non Profit Hospital Under Prospective Pricing. Journal of Economics and Management Strategy, 3, 7–51.CrossRefGoogle Scholar
  24. Stiglitz, J. (1999, June). Incentives and Institutions in the Provision of Health Care in Developing Countries: Towards an Efficient and Equitable Health Care Strategy. Rotterdam: International Health Economic Association. Presented at the iHEA II Meetings, Rotterdam.Google Scholar
  25. Vlaanderen, F. P., Tanke, M. A., Bloem, B. R., Faber, M. J., Eijkenaar, F., Schut, F. T., et al. (2018, July 5). Design and Effects of Outcome-Based Payment Models in Healthcare: A Systematic Review. European Journal of Health Economics.  https://doi.org/10.1007/s10198-018-0989-8.

Copyright information

© The Author(s) 2020

Authors and Affiliations

  1. 1.The World BankNairobiKenya
  2. 2.Radboud University Medical SchoolNijmegenNetherlands
  3. 3.Ministry of Health, Welfare and SportsHagueNetherlands

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