System-wide impacts of hospital payment reforms : evidence from central and eastern Europe and central Asia, Vol. 1 of 1

About

Countries

Data & Research

Learning

News

Projects & Operations

Publications

Topics

Home > Data & Research > Document Search > Report Details

System-wide impacts of hospital payment reforms : evidence from central and eastern Europe and central Asia

Author:	Moreno-Serra, Rodrigo; Wagstaff, Adam;	Collection Title:	Impact Evaluation series ; no. IE 32 Policy Research working paper ; no. WPS 4987
Country:	Europe and Central Asia;	Date Stored:	2009/07/15
Document Date:	2009/07/01	Document Type:	Policy Research Working Paper
Language:	English	Region:	Europe and Central Asia
Report Number:	WPS4987	SubTopics:	Health Monitoring & Evaluation; Health Systems Development & Reform; Health Economics & Finance; Population Policies; Health Law
Volume No:	1 of 1

Summary: 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.


Official Documents Official, scanned versions of documents (may include signatures, etc.)
File Type		Description	File Size (mb)

	PDF 57 pages	Official version*	3.99 (approx.)
	Text	Text version**

* The official version is derived from scanning the final, paper copy of the document and is the official,
archived version including all signatures, charts, etc.

** The text version is the OCR text of the final scanned version and is not an accurate representation of the final text.
It is provided solely to benefit users with slow connectivity.

Permanent URL for this page: http://go.worldbank.org/AY7GIT6K20