Impact of global budget combined with pay-for-performance on the quality of care in county hospitals: a difference-in-differences study design with a propaensity-score-matched control group using data from Guizhou province, China

Abstract Background Provider payment system has a profound impact on health system performance. In 2016, a number of counties in rural Guizhou, China, implemented global budget (GB) for county hospitals with quality control measures. The aim of this study is to measure the impact of GB combined with pay-for-performance on the quality of care of inpatients in county-level hospitals in China. Methods Inpatient cases of four diseases, including pneumonia, chronic asthma, acute myocardial infarction and stroke, from 16 county-level hospitals in Guizhou province that implemented GB in 2016 were selected as the intervention group, and similar inpatient cases from 10 county-level hospitals that still implemented fee-for-services were used as the control group. Propensity matching score (PSM) was used for data matching to control for age factors, and difference-in-differences (DID) models were constructed using the matched samples to perform regression analysis on quality of care for the four diseases. Results After the implementation of GB, rate of sputum culture in patients with pneumonia, rate of aspirin at discharge, rate of discharge with β-blocker and rate of smoking cessation advice in patients with acute myocardial infarction increased. Rate of oxygenation index assessment in patient with chronic asthma decreased 20.3%. There are no significant changes in other indicators of process quality. Conclusions The inclusion of pay-for-performance in the global budget payment system will help to reduce the quality risks associated with the reform of the payment system and improve the quality of care. Future reform should also consider the inclusion of the pay-for-performance mechanism.

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The Effect of Pay for Performance in the Emergency Department on Patient Waiting Times and Quality of Care in Ontario, Canada: A Difference-in-Differences Analysis

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2015.06.028 ◽

2016 ◽

Vol 67 (4) ◽

pp. 496-505.e7 ◽

Cited By ~ 8

Author(s):

Marian J. Vermeulen ◽

Therese A. Stukel ◽

Andrew S. Boozary ◽

Astrid Guttmann ◽

Michael J. Schull

Keyword(s):

Emergency Department ◽

Quality Of Care ◽

Pay For Performance ◽

Waiting Times ◽

Difference In Differences ◽

Patient Waiting

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Faculty Opinions recommendation of Effect of pay-for-performance incentives on quality of care in small practices with electronic health records: a randomized trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718106923.793485134 ◽

2013 ◽

Author(s):

Stewart Babbott

Keyword(s):

Quality Of Care ◽

Electronic Health Records ◽

Randomized Trial ◽

Pay For Performance ◽

Performance Incentives ◽

Health Records ◽

Electronic Health

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Medicare’s Hospital Value-Based Purchasing Program Values Quality over QALYs

Medical Decision Making ◽

10.1177/0272989x211017105 ◽

2021 ◽

pp. 0272989X2110171

Author(s):

Edward C. Norton ◽

Jun Li ◽

Anup Das ◽

Andrew M. Ryan ◽

Lena M. Chen

Keyword(s):

Quality Of Care ◽

Pay For Performance ◽

Health Interventions ◽

Quality Adjusted Life Years ◽

Value Based Purchasing ◽

Quality Performance ◽

Life Years ◽

Policy Adjustments ◽

Quality Adjusted Life

Medicare’s Hospital Value-Based Purchasing Program (HVBP) is the first national pay-for-performance program to combine measures of quality of care with a measure of episode spending. We estimated the implicit tradeoffs between mortality reduction and spending reduction. To earn points in HVBP, a hospital can either lower mortality or reduce spending, creating a tradeoff between the 2 measures. We analyzed the quality performance and earned points of 2814 hospitals using publicly available data. We then quantified the tradeoffs between spending and mortality in terms of quality-adjusted life-years (QALYs). If incentives in the program were balanced, then the tradeoff between spending and QALYs should be comparable with those of high-value health interventions, roughly $50,000 to $200,000 per QALY. Instead, the tradeoff in HVBP was about $1.2 million per QALY. HVBP overvalues improvements in quality of care relative to spending reductions. We propose 2 possible policy adjustments that could improve incentives for hospitals to deliver high-value care.

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