The impact of various hospital payment methods on the behaviour of hospitals has been analysed for a long time (see, for example, Langenbrunner–Wiley, 2002). Cost-containment policies have also been spreading in response to... [ view full abstract ]
The impact of various hospital payment methods on the behaviour of hospitals has been analysed for a long time (see, for example, Langenbrunner–Wiley, 2002). Cost-containment policies have also been spreading in response to growing health care expenditure (Moreno-Serra, 2014), although the evaluation of their impact is still an ongoing issue. How and whether financial constraints, hospital managers and physicians must face under certain provider payment policies, affect medical decisions and therefore treatment costs and quality of care, is a key question for policy making. Budget cap, which is in the focus of our analysis, is considered as an effective policy for cost containment (Moreno-Serra, 2014), however, there is still limited evidence about its potential impact over shifting priorities, rationing services, or lowering quality of care.
Treatment decisions made by hospital managers and physicians should, in principle, follow medical treatment guidelines, however, scarcity of financial resources might limit the service level provided, leading to undesired outcomes. Provision of emergency and urgent care are especially prone to the negative effect of potential limitations of treatment options. Our analysis intends to inform policy makers about how budget caps applied to emergency care might limit the quality of care provided.
Hungarian hospitals are reimbursed by using a DRG-based system with a cap on the total yearly amount paid to the hospital. In July 2012, PTCA treatment of acute myocardiac infarctions (AMIs) was exempted from the cap, and has been financed fully by the health insurance fund ever since. When indicated, PTCA is generally considered as a treatment option superior to alternatives.
In our paper we analyse whether the regulatory change had an effect on treatment decisions of hospitals or not. We use anonymised, individual-level patient data from 2008 to 2015, covering all AMI cases in the country to carry out an impact analysis of the regulatory change. Should the budget cap truly put limitation on the use of PTCA, an increase in PTCA rate after 2012 would be found.
Our results show various types of responses: the number of AMI cases increased, more patients have been transferred to those hospitals which are able to provide PTCA treatments, and the use of PTCA has also become more frequent among AMI patients. There were significant differences found among hospitals, indicating that local managements differ in how they responded to regulatory changes. While improving PTCA rate may lead to better health outcomes, occurrence of upcoding might also be suspected based on the change in the number of AMI cases. It is concluded that the application of budget caps might have had a moderate limiting effect over the quality of treatment.
