Paying for efficiency: Incentivising same-day discharges in the English NHS

James Gaughan, Nils Gutacker (), Katja Grašič, Noemi Kreif, Luigi Siciliani and Andrew Street

Journal of Health Economics, 2019, vol. 68, issue C

Abstract: We study a pay-for-efficiency scheme that encourages hospitals to admit and discharge patients on the same calendar day when clinically appropriate. Since 2010, hospitals in the English NHS are incentivised by a higher price for patients treated as same-day discharge than for overnight stays, despite the former being less costly. We analyse administrative data for patients treated during 2006–2014 for 191 conditions for which same-day discharge is clinically appropriate – of which 32 are incentivised. Using difference-in-difference and synthetic control methods, we find that the policy had generally a positive impact with a statistically significant effect in 14 out of the 32 conditions. The median elasticity is 0.24 for planned and 0.01 for emergency conditions. Condition-specific design features explain some, but not all, of the differential responses.

Keywords: Pay for performance; Prospective payment systems; Activity based funding; Hospital incentives; DRGs; Synthetic control method; Policy evaluation (search for similar items in EconPapers)
JEL-codes: D22 I11 (search for similar items in EconPapers)
Date: 2019
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (4)

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Working Paper: Paying for efficiency: incentivising same-day discharges in the English NHS (2019)
Working Paper: Paying for Efficiency: Incentivising same-day discharges in the English NHS (2018)
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Persistent link: https://EconPapers.repec.org/RePEc:eee:jhecon:v:68:y:2019:i:c:s0167629618306696

DOI: 10.1016/j.jhealeco.2019.102226

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