Hospital performance and payment: impact of integrating pay-for-performance on healthcare effectiveness in Lebanon
Khalife, Jade LU
; Ammar, Walid
; Emmelin, Maria
LU
; El-Jardali, Fadi
and Ekman, Björn
LU
(2020)
In Wellcome Open Research
- Abstract
- Background: In 2014 the Lebanese Ministry of Public Health integrated pay-for-performance into setting hospital reimbursement tiers, to provide hospitalization service coverage for the majority of the Lebanese population. This policy was intended to improve effectiveness by decreasing unnecessary hospitalizations, and improve fairness by including risk-adjustment in setting hospital performance scores.
Methods: We applied a systematic approach to assess the impact of the new policy on hospital performance. The main impact measure was a national casemix index, calculated across 2011-2016 using medical discharge and surgical procedure codes. A single-group interrupted time series analysis model with Newey ordinary least squares... (More) - Background: In 2014 the Lebanese Ministry of Public Health integrated pay-for-performance into setting hospital reimbursement tiers, to provide hospitalization service coverage for the majority of the Lebanese population. This policy was intended to improve effectiveness by decreasing unnecessary hospitalizations, and improve fairness by including risk-adjustment in setting hospital performance scores.
Methods: We applied a systematic approach to assess the impact of the new policy on hospital performance. The main impact measure was a national casemix index, calculated across 2011-2016 using medical discharge and surgical procedure codes. A single-group interrupted time series analysis model with Newey ordinary least squares regression was estimated, including adjustment for seasonality, and stratified by case type. Code-level analysis was used to attribute and explain changes in casemix index due to specific diagnoses and procedures.
Results: Our final model included 1,353,025 cases across 146 hospitals with a post-intervention lag-time of two months and seasonality adjustment. Among medical cases the intervention resulted in a positive casemix index trend of 0.11% per month (coefficient 0.002, CI 0.001-0.003), and a level increase of 2.25% (coefficient 0.022, CI 0.005-0.039). Trend changes were attributed to decreased cases of diarrhea and gastroenteritis, abdominal and pelvic pain, essential hypertension and fever of unknown origin. A shift from medium to short-stay cases for specific diagnoses was also detected. Level changes were attributed to improved coding practices, particularly for breast cancer, leukemia and chemotherapy. No impact on surgical casemix index was found.
Conclusions: The 2014 policy resulted in increased healthcare effectiveness, by increasing the casemix index of hospitals contracted by the Ministry. This increase was mainly attributed to decreased unnecessary hospitalizations and was accompanied by improved medical discharge coding practices. Integration of pay-for-performance within a healthcare system may contribute to improving effectiveness. Effective hospital regulation can be achieved through systematic collection and analysis of routine data. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/0b26e930-4502-4175-aa79-d6be3b1d4a48
- author
- Khalife, Jade
LU
; Ammar, Walid
; Emmelin, Maria
LU
; El-Jardali, Fadi
and Ekman, Björn
LU
- organization
- publishing date
- 2020
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Wellcome Open Research
- article number
- 95
- publisher
- F1000 Research Ltd.
- external identifiers
-
- scopus:85099726255
- pmid:33437874
- ISSN
- 2398-502X
- DOI
- 10.12688/wellcomeopenres.15810.2
- language
- English
- LU publication?
- yes
- id
- 0b26e930-4502-4175-aa79-d6be3b1d4a48
- date added to LUP
- 2020-12-18 14:57:15
- date last changed
- 2024-06-21 02:16:06
@article{0b26e930-4502-4175-aa79-d6be3b1d4a48,
abstract = {{Background: In 2014 the Lebanese Ministry of Public Health integrated pay-for-performance into setting hospital reimbursement tiers, to provide hospitalization service coverage for the majority of the Lebanese population. This policy was intended to improve effectiveness by decreasing unnecessary hospitalizations, and improve fairness by including risk-adjustment in setting hospital performance scores.<br/>Methods: We applied a systematic approach to assess the impact of the new policy on hospital performance. The main impact measure was a national casemix index, calculated across 2011-2016 using medical discharge and surgical procedure codes. A single-group interrupted time series analysis model with Newey ordinary least squares regression was estimated, including adjustment for seasonality, and stratified by case type. Code-level analysis was used to attribute and explain changes in casemix index due to specific diagnoses and procedures.<br/>Results: Our final model included 1,353,025 cases across 146 hospitals with a post-intervention lag-time of two months and seasonality adjustment. Among medical cases the intervention resulted in a positive casemix index trend of 0.11% per month (coefficient 0.002, CI 0.001-0.003), and a level increase of 2.25% (coefficient 0.022, CI 0.005-0.039). Trend changes were attributed to decreased cases of diarrhea and gastroenteritis, abdominal and pelvic pain, essential hypertension and fever of unknown origin. A shift from medium to short-stay cases for specific diagnoses was also detected. Level changes were attributed to improved coding practices, particularly for breast cancer, leukemia and chemotherapy. No impact on surgical casemix index was found.<br/>Conclusions: The 2014 policy resulted in increased healthcare effectiveness, by increasing the casemix index of hospitals contracted by the Ministry. This increase was mainly attributed to decreased unnecessary hospitalizations and was accompanied by improved medical discharge coding practices. Integration of pay-for-performance within a healthcare system may contribute to improving effectiveness. Effective hospital regulation can be achieved through systematic collection and analysis of routine data.}},
author = {{Khalife, Jade and Ammar, Walid and Emmelin, Maria and El-Jardali, Fadi and Ekman, Björn}},
issn = {{2398-502X}},
language = {{eng}},
publisher = {{F1000 Research Ltd.}},
series = {{Wellcome Open Research}},
title = {{Hospital performance and payment: impact of integrating pay-for-performance on healthcare effectiveness in Lebanon}},
url = {{http://dx.doi.org/10.12688/wellcomeopenres.15810.2}},
doi = {{10.12688/wellcomeopenres.15810.2}},
year = {{2020}},
}