System-Wide Impacts of Hospital Payment Reforms: Evidence from Central and Eastern Europe and Central Asia

57 Pages Posted: 20 Apr 2016

See all articles by Rodrigo Moreno-Serra

Rodrigo Moreno-Serra

University of York - Department of Economics & Centre for Health Economics

Adam Wagstaff

World Bank - Development Research Group (DECRG)

Date Written: July 1, 2009

Abstract

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.

Keywords: Health Monitoring & Evaluation, Health Systems Development & Reform, Health Economics & Finance, Health Law, Population Policies

Suggested Citation

Moreno-Serra, Rodrigo and Wagstaff, Adam, System-Wide Impacts of Hospital Payment Reforms: Evidence from Central and Eastern Europe and Central Asia (July 1, 2009). World Bank Policy Research Working Paper No. 4987. Available at SSRN: https://ssrn.com/abstract=1429256

Rodrigo Moreno-Serra

University of York - Department of Economics & Centre for Health Economics ( email )

York YO10 5DD
United Kingdom
+44 1904 321 411 (Phone)

Adam Wagstaff

World Bank - Development Research Group (DECRG) ( email )

1818 H. Street, N.W.
MSN3-311
Washington, DC 20433
United States

HOME PAGE: http://econ.worldbank.org/staff/awagstaff

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