Does the Extent of per Case Payment System Affect Hospital Efficiency?

2016 ◽  
Vol 46 (1) ◽  
pp. 117-149 ◽  
Author(s):  
Marina Cavalieri ◽  
Calogero Guccio ◽  
Domenico Lisi ◽  
Giacomo Pignataro
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Prospective Payment System ◽  
Interesting Case ◽  
Payment System ◽  
Prospective Payment ◽  
Care Services ◽  
Global Budgeting ◽  
Related Group ◽  
National Governments

Recently increasing public pressure to contain costs in the health care sector has led many national governments to introduce some type of prospective payment system and reduce the scope of global budgeting. This study investigates the extent to which the reimbursement systems of the Italian hospital sector have an impact on hospitals’ technical efficiency. Because of high variation in the financing and provision of health care services among regions and hospitals, Italy represents an interesting case study to test these effects. A two-stage data envelopment analysis was employed, in which the efficiency scores of all Italian hospitals were first calculated and then regressed on different environmental variables to capture the role of reimbursement systems. The results found a significant impact of the use of diagnostic-related group-based prospective payment systems on hospitals’ efficiency.

scholarly journals Isomorphic Pressures and Innovation Trends in Italian Health Care Organizations

2017 ◽  
Vol 12 (6) ◽  
pp. 26
Author(s):  
Stefania De Simone
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Quality Care ◽  
Prospective Payment System ◽  
Health Care Sector ◽  
Institutional Pressures ◽  
Organizational Models ◽  
Healthcare Organizations ◽  
Care Services ◽  
Isomorphic Pressures

Over 20 years, hospitals in Italy as well as in other European countries have evolved and changed in response to institutional pressures. With the corporatization, there has been the entrance of new logics and governance structures that contributed to a transformation of the health system. The survival of healthcare organizations is dictated not only by the technical conditions, that allow efficiently and effectively operating, but also by the ability to comply with rules to get legitimacy from external institutional actors. Organizations in a population adapt to their environment, in which operate, so many other organizations adapting to it (isomorphism). The purpose of this paper is to discuss a theoretical framework based on neo-institutional approach that could explain the influence of isomorphic pressures on innovative processes in health care sector. Qualitative data from literature on neo-institutional theory applied to health care sector have been analyzed. Findings reveal institutional pressures stimulate the development of innovations and organizational learning. This concept concerns both the fit of the organization with its environment (strategic matters) and effective implementation of strategies. Hospitals must find ways to increase profit, by improving medical capabilities for payment health care services. One of the most important isomorphic pressure is the prospective payment system for health care that had effects on the choices of organizational models to adopt. The challenge for hospital administrators is to seek consistency between efficiency and quality care.

New Zealand’s Primary Health Care Strategy: early effects of the new financing and payment system for general practice and future challenges

2009 ◽  
Vol 6 (1) ◽  
pp. 1-21 ◽  
Author(s):  
Jacqueline Cumming ◽  
Nicholas Mays
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Care Services ◽  
Payment System ◽  
Fee For Service ◽  
Universal System ◽  
Care Services ◽  
Primary Health ◽  
Primary Health Care Services ◽  
Early Effects

AbstractSince 2001, implementation of a New Zealand’s Primary Health Care Strategy (the Strategy) has led to an increase in the proportion of primary health care services which are publicly funded, the development of 82 primary health organisations (PHOs) to oversee primary health care services and universal public capitation funding of PHOs. This approach has replaced the previous system of fee-for service targeted public subsidies paid to individual general practitioners (GPs). Patient copayments, although at a reduced level but still set by individual practitioners, have remained a core feature of the system.This paper focuses on the implementation and impact of key policy changes over the first five years of the Strategy. Although patient copayments have fallen and consultation rates have increased, the new funding and payment system has raised a number of unresolved issues – whether to retain the new universal funding system or revert to the former targeted approach; how to achieve the potential gains from capitation when GPs continue to receive their income from a variety of sources and in a variety of different ways; and how to manage the potential for ‘cream skimming’.Recent improvements in access may, in time, improve health status and reduce inequalities in health, but there is no guarantee that a universal system will necessarily improve average health or reduce inequalities. Much depends on the services being delivered and the populations that are benefiting most – something New Zealand needs better evidence on before determining future policy directions in primary health care.

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