Kommentar zu "Can payers use prices to improve quality? Evidence from English hospitals"

Resumen o Introducción

The “Best Practice Tariff”-program (BPT) is one of many pay-for-performance models which have been introduced in the health system of the United Kingdom (UK). The first one was the "Quality and Outcome Framework" (QOF) followed by "Advancing Quality" (AQ), Commissioning for Quality and Innovation (CQUIN), "Non-Payment Policies" (NPP) until 2010, where the BPT has started. First, it was used in four indicators: cataract, gall bladder removal, stroke and fragility hip fracture. Now, the BPT includes 50 procedures in the UK. The payment of the service providers is based on the principles of the best treatment and therefore it does not depend on the average costs and can thus be higher or lower than the previously determined flat rate. The BPT can consequently be regarded as a punishment for hospitals that are not working compliant. The purpose of the BPT is to change treatments from inpatient cases to outpatient daycases, to reduce the number of appointments for patients and to increase the quality of the results. In the article by Allen et al. from 2016, the impact of the BPT on one of the four primary treatment cases, cholecystectomy, was investigated. Cholecystectomy is an operation in which the gallbladder is removed under general anesthesia, either laparoscopically or as an open surgery. Laparoscopic cholecystectomy is classified as an intervention in the UK, which can be performed as a daycase event. The aim of the BPT for cholecystectomy was to motivate the hospitals to carry out the procedure more frequently as a daycase event without losing quality. To investigate the effects of BPT, Allen et al. analyzed data from the Hospital Episodes Statistics from 1 December 2007 (before BPT) to 31 March 2011 (after introducing BPT). For this research, the cholecystectomy was compared with a control group consisting out of procedures from other medical fields (for example ear, nose, neck). After the evaluation Allen et al. came to the conclusion that a potential effect of the policy is visible. The concrete investigation results are discussed in Chapter 2.