Payment by Results or Payment by Outcome? The History of Measuring Medicine

O’Connor, Rory J; Neumann, Vera

doi:10.1177/014107680609900513

Cited by 13 publications

(7 citation statements)

References 45 publications

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“…The calculation of the national tariffs is complex and prone to error [5][6][7]. There has been no standardisation in how hospitals calculate their reference costs.…”

Section: Implications Of Our Results For Understanding Pbrmentioning

confidence: 99%

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Factors affecting the profitability of surgical procedures under ‘Payment by Results’

Abbott¹,

White

Pandit

2011

Anaesthesia

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SummaryWe wished to analyse the factors influencing the potential profitability of surgical operations under the National Health Service 'Payment by Results' scheme. First, we planned to develop a generic theoretical model describing the relationships between 'profit', 'procedure duration' and 'costs'. Second, for a group of specific operations, we planned to investigate (using analysis of hypothetical lists) whether it was possible for hospitals to make a profit when lists were maximally efficient. 'Efficient' meant full utilisation of the list time, with no gaps between cases and no case cancellations. We assumed that operating theatres cost a median of £16.min )1 (range £12-20.min )1 or $£7680 for an 8-h list), and we used published mean (SD) times for seven common day-case operations (varicose veins, inguinal hernia, cataract, circumcision, hydrocoele, cystoscopy, breast biopsy). We found that even when conducted perfectly efficiently, some operations (notably varicose veins) were always unprofitable. Conversely, other operations (notably cataracts) would be likely to be profitable even if conducted inefficiently. We conclude that current tariffs do not properly reward efficiency. As tariffs are based in large part on hospitals' reporting their own costs, flaws in the tariffs are likely to be due to inaccurate reporting. Even for this imperfect funding system, our theoretical model may help to develop strategies to maximise profit. Our analysis suggests alternative ways in which reimbursement systems could be designed to avoid creating perverse incentives and instead properly reward efficient practices.

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“…The calculation of the national tariffs is complex and prone to error [5][6][7]. There has been no standardisation in how hospitals calculate their reference costs.…”

Section: Implications Of Our Results For Understanding Pbrmentioning

confidence: 99%

“…Yet, alternative analyses of PbR suggest that deciding optimum strategies is not so simple. The calculation of the national tariffs is itself so complex that it is prone to error [5][6][7][8]. Hearnden and Tennant have argued that HRGs are too general to take into account specifics of different surgical procedures for the same condition [9].…”

mentioning

confidence: 99%

Factors affecting the profitability of surgical procedures under ‘Payment by Results’

Abbott¹,

White

Pandit

2011

Anaesthesia

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“…The Audit Commission report on P4P for local services describes a ‘potentially useful’ approach, given clearly defined service users and outcomes, measured baseline performance and reliable means of attributing changes to provider actions. The notion of paying for patient outcomes, as opposed to quantity of throughput, may seem laudable, but concern has been raised over the lack of evidence on improvement in health care to support its implementation . In the absence of a conclusive evidence base, it is important to understand the impact of P4P.…”

Section: Introductionmentioning

confidence: 99%

Does paying service providers by results improve recovery outcomes for drug misusers in treatment in England?

et al. 2017

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“…In general medicine, until recent times, mortality was the most important, and often the only, health outcome that was considered when guiding care [6]. However, medical care is so powerful and complex now, that we unarguably need more sophisticated tools [7].…”

mentioning

confidence: 99%

The outcomes of haemophilia and its treatment: why we need a core set

Feldman

2017

Haemophilia

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Payment by Results or Payment by Outcome? The History of Measuring Medicine

Cited by 13 publications

References 45 publications

Factors affecting the profitability of surgical procedures under ‘Payment by Results’

Factors affecting the profitability of surgical procedures under ‘Payment by Results’

Does paying service providers by results improve recovery outcomes for drug misusers in treatment in England?

The outcomes of haemophilia and its treatment: why we need a core set

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