nach oben

International Journal of Health Economics and Management

Erschienen in:

01.12.2014

The impact of global budgeting on treatment intensity and outcomes

verfasst von: Kamhon Kan, Shu-Fen Li, Wei-Der Tsai

Erschienen in: International Journal of Health Economics and Management | Ausgabe 4/2014

Einloggen, um Zugang zu erhalten

Abstract

This paper investigates the effects of global budgets on the amount of resources devoted to cardio-cerebrovascular disease patients by hospitals of different ownership types and these patients’ outcomes. Theoretical models predict that hospitals have financial incentives to increase the quantity of treatments applied to patients. This is especially true for for-profit hospitals. If that’s the case, it is important to examine whether the increase in treatment quantity is translated into better treatment outcomes. Our analyses take advantage of the National Health Insurance of Taiwan’s implementation of global budgets for hospitals in 2002. Our data come from the National Health Insurance’s claim records, covering the universe of hospitalized patients suffering acute myocardial infarction, ischemic heart disease, hemorrhagic stroke, and ischemic stroke. Regression analyses are carried out separately for government, private not-for-profit and for-profit hospitals. We find that for-profit hospitals and private not-for-profit hospitals did increase their treatment intensity for cardio-cerebrovascular disease patients after the 2002 implementation of global budgets. However, this was not accompanied by an improvement in these patients’ mortality rates. This reveals a waste of medical resources and implies that aggregate expenditure caps should be supplemented by other designs to prevent resources misallocation.

Nur mit Berechtigung zugänglich

Exceptions are Chang et al. (2011) and Tung and Chang (2010), who examine the effect of reductions in reimbursements on the outcomes of AMI and stroke patients.

The shares of the overall mortality rates and NHI inpatient expenditures for these diseases are 2.85 and 1.06 % (AMI), 4.90 and 4.52 % (ischemic heart diseases), 1.28 and 1.86 % (hemorrhagic stroke), and 2.37 and 1.54 % (ischemic stroke) in 2002. See Department of Health (2003a, b).

Benstetter, F., & Wambach, A. (2006). The treadmill effect in a fixed budget system. Journal of Health Economics, 25, 146–169.PubMedCrossRef

Chang, G.-M., Cheng, S.-H., & Tung, Y.-C. (2011). Impact of cuts in reimbursement on outcome of acute myocardial infarction and use of percutaneous coronary intervention: a nationwide population-based study over the period 1997 to 2008. Medical Care, 49(12), 1054–1061.PubMedCrossRef

Chen, F. J., Laditka, J. N., Laditka, S. B., & Xirasagar, S. (2007). Providers’ response to global budgeting in Taiwan: What were the initial effects? Health Service Management Research, 20, 113–120.CrossRef

Cheng, S.-H., Chen, C.-C., & Chang, W.-L. (2009). Hospital response to a global budget program under universal health insurance in Taiwan. Health Policy, 92(2–3), 158–164.PubMedCrossRef

Cheng, S.-H., Chen, C.-C., & Tsai, S.-L. (2012). The impacts of DRG-based payments on health care provider behaviors under a universal coverage system: A population-based study. Health Policy, 107(2–3), 202–208.PubMedCrossRef

Christianson, J. B., & Conrad, D. (2011). Provider payment and incentives. In S. Glied & P. C. Smith (Eds.), The Oxford handbook of health economics. Oxford: Oxford University Press.

Cutler, D. M. (1995). The incidence of adverse medical outcomes under prospective payment. Econometrica, 63(1), 29–50.CrossRef

Dafny, L. S. (2005). How do hospitals respond to price changes? The American Economic Review, 95, 1525–1547.CrossRef

Department of Health. (2003a). Statistics of Causes of Death, 2002. Republic of China (Taiwan): Executive Yuan.

Department of Health. (2003b). Health Statistics in Taiwan, 2002. Republic of China (Taiwan): Executive Yuan.

Docteur, E., & Oxley, H. (2004). Health-system reform: Lessons from experience. In Towards High-Performing Health Systems. OECD Policy Studies, Paris: Organization for Economic Co-Operation and Development.

Duggan, M. G. (2000). Ownership and public medical spending. Quarterly Journal of Economics, 115, 1343–1373.CrossRef

Fan, C. P., Chen, K. P., & Kan, K. (1998). The design of payment systems for physicians under global budget—an experimental study. Journal of Economic Behavior and Organization, 34(2), 295–311.CrossRef

Eggleston, K., Shen, Y.-C., Lau, J., Schmid, C. H., & Chan, J. (2008). Hospital Ownership and quality of care: What explains the different results in the literature? Health Economics, 17, 1345–1362.PubMedCrossRef

Hansmann, H. (1980). The role of nonprofit enterprise. Yale Law Journal, 89, 835–901.CrossRef

Hsiao, C. (2003). Analysis of panel data (2nd ed.). Cambridge: Cambridge University Press.CrossRef

Horwitz, J. R. (2005). Making profits and providing care: Comparing nonprofit, for-profit, and government hospitals. Health Affairs, 24, 790–801.PubMedCrossRef

Horwitz, J., & Nichols, A. (2009). Hospital ownership and medical services: Market mix, spillover effects and nonprofit objectives. Journal of Health Economics, 28, 924–937.PubMedCrossRef

Hurley, J., Lomas, J., & Goldsmith, L. J. (1997). Physician responses to global physician expenditure budgets in Canada: A common property perspective. The Milbank Quarterly, 75(3), 343–364.PubMedCrossRefPubMedCentral

Kornai, J. (1986). The soft budget constraint. Kyklos, 39, 3–30.CrossRef

Kornai, J. (2009). The soft budget constraint syndrome in the hospital sector. International Journal of Health Care Finance and Economics, 9, 117–135.PubMedCrossRef

Kornai, J., Maskin, E., & Roland, G. (2003). Understanding the soft budget constraint. Journal of Economic Literature, 41, 1095–1136.CrossRef

Le Grand, J. (2003). Methods of cost containment: Some lessons from Europe. Working Paper, London School of Economics.

Lee, D. S., & Lemieux, T. (2010). Regression discontinuity designs in economics. Journal of Economic Literature, 48, 281–355.CrossRef

Lee, M. C., & Jones, A. M. (2004). How did dentists respond to the introduction of global budgets in Taiwan? An evaluation using individual panel data. International Journal of Health Care Finance and Economics, 4, 307–326.PubMedCrossRef

Lien, H.-M., Chou, S.-Y., & Liu, J.-T. (2008). Hospital ownership and performance: Evidence from stroke and cardiac treatment in Taiwan. Journal of Health Economics, 27(5), 1208–1223.PubMedCrossRef

Louis, D. Z., Yuen, E. J., Braga, M., Cicchetti, A., Rabinowitz, C., Laine, C., & Gonnella, J. S. (1999). Impact of a DRG-based hospital financing system on quality and outcomes of care in Italy. Health Service Research, 34(1 Part 2), 405–415.

McClellan, M. B., & Staiger, D. O. (2000). Comparing hospital quality at for-profit and not-for-profit hospitals Chapter 3. In D. M. Cutler (Ed.), The changing hospital industry: Comparing for-profit and not-for-profit institutions (pp. 93–112). Chicago: University of Chicago Press.

Miller, H. D. (2009). From volume to value: Better ways to pay for health care. Health Affairs, 28(5), 1418–1428.PubMedCrossRef

Mougeot, M., & Naegelen, F. (2005). Hospital price regulation and expenditure cap policy. Journal of Health Economics, 24, 55–72.PubMedCrossRef

Rogers, W. H., Draper, D., Kahn, K. L., Keeler, E. B., Rubenstein, L. V., Kosecoff, J., et al. (1990). Quality of care before and after implementation of the DRG-based prospective payment system: A summary of effects. Journal of American Medical Association, 264(15), 1989–1994.CrossRef

Rochaix, L. (1993). Financial incentives for physicians: the Quebec experience. Health Economics, 2, 163–176.PubMedCrossRef

Silverman, E., & Skinner, J. (2004). Medicare upcoding and hospital ownership. Journal of Health Economics, 23, 369–389.PubMedCrossRef

Shen, Y.-C., & Eggleston, K. (2009). The effect of soft budget constraints on access and quality in hospital care. International Journal of Health Care Finance and Economics, 9, 211–232.PubMedCrossRef

Sloan, F. A. (2000). Not-for-profit ownership and hospital behavior. In: Culyer, A. J., Newhouse, J. P. (Eds.) Handbook of Health Economics, Vol. 1, Part B (pp. 1141–1174). Elsevier.

Sloan, F. A., Picone, G. A., Taylor, D. H, Jr, & Chou, S.-Y. (2001). Hospital ownership and cost and quality of care: Is there a dime’s worth of difference? Journal of Health Economics, 20, 1–21.PubMedCrossRef

Tung, Y.-C., & Chang, G.-M. (2010). The effect of cuts in reimbursement on stroke outcome: A nationwide population-based study during the period 1998 to 2007. Stroke, 41(3), 504–509.PubMedCrossRef

Weisbrod, B. (1977). Voluntary nonprofit sector. Lexington, Mass: DC Heath.

Wilson, J. (1989). Bureaucracy. Washington, D.C.: Basic Books.

Wolfe, P. R., & Moran, D. W. (1993). Global budgeting in the OECD countries. Health Care Financing Review, 14(3), 55–76.PubMed

Titel: The impact of global budgeting on treatment intensity and outcomes
verfasst von: Kamhon Kan
Shu-Fen Li
Wei-Der Tsai
Publikationsdatum: 01.12.2014
Verlag: Springer US
Erschienen in: International Journal of Health Economics and Management / Ausgabe 4/2014
Print ISSN: 2199-9023
Elektronische ISSN: 2199-9031
DOI: https://doi.org/10.1007/s10754-014-9150-0

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

The impact of global budgeting on treatment intensity and outcomes

Abstract

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2014

Does a global budget superimposed on fee-for-service payments mitigate hospitals’ medical claims in Taiwan?

Payment generosity and physician acceptance of Medicare and Medicaid patients

The effect of social health insurance on prenatal care: the case of Ghana

Health care expenditure decisions in the presence of devolution and equalisation grants

Changing healthcare capital-to-labor ratios: evidence and implications for bending the cost curve in Canada and beyond