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Paying for Efficiency: Incentivising same-day discharges in the English NHS

Author

Listed:
  • James Gaughan

    (Centre for Health Economics, University of York, York, UK)

  • Nils Gutacker

    (Centre for Health Economics, University of York, York, UK)

  • Katja Grasic

    (Centre for Health Economics, University of York, York, UK)

  • Noemi Kreif

    (Centre for Health Economics, University of York, York, UK)

  • Luigi Siciliani

    (Department of Economics and Related Studies, University of York, York, UK)

  • Andrew Street

    (Department of Health Policy, The London School of Economics and Political Science, UK)

Abstract
We study a pay-for-efficiency scheme that encourages hospitals to admit and discharge patients on the same calendar day where clinically appropriate. Since 2010, hospitals in the English NHS receive a higher price for patients treated as same-day discharge than for overnight stays, despite the former being less costly. We analyse administrative data for patients treated for 191 conditions for which same-day discharge is clinically appropriate — of which 32 are incentivised — during 2006-2014. Using interrupted time series, differences-in-differences and synthetic control methods, we find that the policy generally had a positive effect on planned conditions with a statistically significant effect in about a third of conditions. The results are more mixed for emergency conditions. The median elasticity (across all 32 conditions) is 0.09 but above one for six conditions. Condition-specific design features explain some, but not all, of the differential responses.

Suggested Citation

  • James Gaughan & Nils Gutacker & Katja Grasic & Noemi Kreif & Luigi Siciliani & Andrew Street, 2018. "Paying for Efficiency: Incentivising same-day discharges in the English NHS," Working Papers 157cherp, Centre for Health Economics, University of York.
    • Handle: RePEc:chy:respap:157cherp
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    Cited by:

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    2. Gintare Valentelyte & Conor Keegan & Jan Sorensen, 2021. "Analytical methods to assess the impacts of activity-based funding (ABF): a scoping review," Health Economics Review, Springer, vol. 11(1), pages 1-15, December.
    3. Huitfeldt, Ingrid, 2021. "Hospital reimbursement and capacity constraints: Evidence from orthopedic surgeries," Health Policy, Elsevier, vol. 125(6), pages 732-738.
    4. Idaira Rodriguez Santana & María José Aragón & Nigel Rice & Anne Rosemary Mason, 2020. "Trends in and drivers of healthcare expenditure in the English NHS: a retrospective analysis," Health Economics Review, Springer, vol. 10(1), pages 1-11, December.
    5. Kreutzberg, Anika & Eckhardt, Helene & Milstein, Ricarda & Busse, Reinhard, 2024. "International strategies, experiences, and payment models to incentivise day surgery," Health Policy, Elsevier, vol. 140(C).

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    More about this item

    Keywords

    Pay for Performance; Best Practice Tariff; day surgery; same-day discharge; policy evaluation;
    All these keywords.

    JEL classification:

    • D22 - Microeconomics - - Production and Organizations - - - Firm Behavior: Empirical Analysis
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets

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