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How should hospital reimbursement be refined to support concentration of complex care services?
Author(s) -
Bojke Chris,
Grašič Katja,
Street Andrew
Publication year - 2018
Publication title -
health economics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.55
H-Index - 109
eISSN - 1099-1050
pISSN - 1057-9230
DOI - 10.1002/hec.3525
Subject(s) - reimbursement , payment , disadvantaged , business , health care , payment system , construct (python library) , prospective payment system , actuarial science , service (business) , public economics , finance , economics , marketing , computer science , economic growth , programming language
Abstract The English National Health Service is promoting concentration of the treatment of patients with relatively rare and complex conditions into a limited number of specialist centres. If these patients are more costly to treat, the prospective payment system based on Healthcare Resource Groups (HRGs) may need refinement because these centres will be financially disadvantaged. To assess the funding implications of this concentration policy, we estimate the cost differentials associated with caring for patients that receive complex care and examine the extent to which complex care services are concentrated across hospitals and HRGs. We estimate random effects models using patient‐level activity and cost data for all patients admitted to English hospitals during the 2013/14 financial year and construct measures of the concentration of complex services. Payments for complex care services need to be adjusted if they have large cost differentials and if provision is concentrated within a few hospitals. Payments can be adjusted either by refining HRGs or making top‐up payments to HRG prices. HRG refinement is preferred to top‐payments the greater the concentration of services among HRGs.