D6.8 – Database of existing incentives for hospitals
Every country tinkers with the way it pays its hospitals. One adds a bonus for treating hip fractures within forty eight hours, another docks payment when too many patients are readmitted, a third switches an entire specialty from a fixed budget to payment per case. Each of these experiments has usually been studied by someone, somewhere, and written up in a journal. The trouble is that the findings sit scattered across hundreds of separate articles, each with its own vocabulary, its own patient group and its own way of reporting whether the change actually worked. Anyone trying to answer a practical question, such as whether penalties reduce length of stay or whether quality bonuses improve survival, has to reconstruct the answer from scratch. This deliverable turns that scattered literature into something you can query.
The database organises the evidence gathered in the systematic review of D6.7 into a structured workbook of more than fifty linked tables, built around four ways of entering the material: by payment mechanism, by type of incentive, by observed impact, and by country. Every study is coded along a common set of dimensions, so that a single record links the payment mechanism involved (fee for service, per diem, DRG, global budget, bundled payment, capitation, pay for performance or shared savings, grouped into the four families of activity based, budget, consolidated and incremental models) to one of eleven categories of incentive, from bonuses and penalties and bonus malus schemes to price changes and outright switches to a new payment method, and then to one of seventeen measured outcomes ranging from casemix, waiting times and number of patients through survival, adverse events and patient satisfaction to revenues, costs, length of stay, readmissions, upcoding and payer spending. Crucially, each entry records not only what was measured but how it turned out: the direction of the effect, whether it reached statistical significance, how long the observation period lasted, and an assessment of the study’s methodological quality based on an adaptation of the EPHPP Quality Assessment Tool for Quantitative Studies. Further tables add the population studied, including the number of hospitals, their ownership and bed size, the ward type, the therapeutic area and the age and residence of the patients concerned. The result covers twenty one countries and allows both broad comparisons, such as which payment mechanisms have been tried where, and narrow ones, such as what happens to costs specifically when a bonus is attached to a pay for performance scheme.
What the deliverable contains:
- An Excel workbook of over fifty cross referenced tables, organised into four analytical entry points: payment mechanisms, incentives, impacts and countries
- A dictionary defining every payment mechanism, incentive category and outcome used in the coding, ensuring consistent terminology across the whole database
- Detailed impact tables recording, for each incentive, the direction and statistical significance of the effect, the duration of the observation period and the methodological quality of the underlying study
- Population tables describing the hospitals and patients studied, including ownership, bed size, ward type, therapeutic area and patient age
- Country tables mapping which payment mechanisms, incentives and measured effects have been documented in each of twenty one countries
Download: D6.8 – Database of existing incentives for hospitals