Work package 4 Hospital care WP Leader: Giacomo Pignataro Università di Catania

2 General objectives In line with the general objectives of InterQuality, WP4 aims at providing the relevant elements for choosing the “right” financing mechanism for hospital care  Investigation of the effects of different prospective payment systems on the hospitals’ performance  Policy recommendations on the desirability of the adoption of prospective payment systems for hospital care

3 The approach Empirical analysis shows a high degree of variability of the effects attributable to prospective payment mechanisms this variability affects the reliability of policy recommendations about the adoption of these mechanisms The basic idea is to consider different features characterizing health care systems, which may affect the actual realization of expected incentives, so as to relate policy recommendations to each country peculiarities

4 Overall work plan  Description of payment systems for hospital care, with a focus on Denmark, Italy and UK  Theoretical analysis of the relationship between some relevant features of health care systems and the incentives provided by prospective payment mechanisms  Empirical analysis of the effects of prospective payment systems, for hospital care in the Italian regions, Denmark and UK  Policy implications and recommendations

Comparative analysis of European reimbursement systems for hospital care  Objectives Description of the specific ways prospective payment systems, for reimbursing hospital care, have been implemented in Denmark, Italy and UK Comparative analysis of the three systems so as to: –Identify the range of differences characterizing the implementation of prospective payment systems – augmented with some of the outputs of WP1 as well as of other research projects (e.g. EuroDRG, HOPE study on DRGs) –Analyse the impact of these differences, in terms of the typical incentives provided by prospective payment systems, drawing also on the results of WP1, w.r.t. hospital care –Provide a primer analysis of how the specific implementation of prospective payment systems is related to the specific features of a country healthcare system

6  Methodology The description of the reimbursement systems for hospital care in each country will be framed within the general features of prospective payment mechanisms, taking into account a set of relevant incentives (financial and non-financial) – drawing on results from WP1, EuroDRG and HOPE studies: 1.The weight of PPS-related funding in the overall funding mix 2.The characteristics of the PPS reimbursement 3.The introduction of measures to cope with the hazardous incentives brought about by PPS 4.The interrelation between PPS and the organization of the hospital care system Comparative analysis of European reimbursement systems for hospital care

 Output Report on the implementation of prospective payment systems in the hospital care sector in Denmark, Italy and UK (D 4.1.1) - we have already a draft of sub-reports for each country  Timing End: March 2012  Partners SDU and UY, as for the description of the payment system in their countries – comparative analysis is the main responsibility of UniCT 7

8 4.2 – Prospective payment systems and characteristics of health care systems  Objectives Evaluate the potential impact of relevant features of healthcare systems on the typical incentives provided by different prospective payment systems, so as to provide a basis to relate the policy recommendations to the peculiarities of a country’s system

9  Methodology Theoretical analysis, consisting of: –identification of the most important general characteristics of payment systems, following the work done in Task 4.1 –identification of a set of crucial features of health care systems, especially of hospital care provision, which may affect the actual realization of the expected incentives. Just as an example, it is possible to mention the composition of supply of health care services (hospital care, primary care, ambulatory care, etc.), the degree of public-private mix in the supply of hospital services, the mix of financing methods for the different providers, etc.: A very important basis for this work is the research on Typology carried out within WP1 4.2 – Prospective payment systems and characteristics of health care systems

10 –Construction of the following matrix each cell will be filled in with a theoretical discussion of the potential effects of a given configuration of the payment system (as identified in each row of the matrix) as related to each specific characteristic of health care provision (as identified in each column of the matrix) – draw also on the results of WP1 (Task 1.1) 4.2 – Prospective payment systems and characteristics of health care systems

11  Output Report on the effects of prospective payment systems as related to important characteristics of health care provision (D – part of D 4.1 Report on financing hospital care)  Timing Start: January 2012 – End: May 2012  Partners The task will be mainly performed by WP leader. The framework of analysis will be mainly discussed with SDU and UY 4.2 – Prospective payment systems and characteristics of health care systems

– A highly decentralized country as a natural experiment: Italy  Objectives Exploiting the differences in organizational and financing models across the Italian regions, test the empirical relevance of the impact of the different characteristics of regional health care systems on the incentives attributed to prospective payment systems, alongside the analysis carried out in 4.2

13  Methodology Identification of the relevant data (routine and research-specific micro data) – relevance of results of WP2 Selection of at least four representative regions (population, regulatory system, extension and homogeneity of data, etc.) Collection of data Choice of empirical strategy, consistent with the theoretical framework developed in 4.2 Guidelines for the application of the overall methodology to Denmark and UK 4.3 – A highly decentralized country as a natural experiment: Italy

14  Output Report (part 1) on the empirical analysis of the effects of the use of a prospective payment system in the Italian, Danish and UK hospital care sector (D – part of D 4.1 “Report on financing hospital care”)  Timing Start: February 2012 – End: November 2012  Partners The identification of the relevant data for the analysis and the elaboration of methodological guidelines will be shared with SDU and UY (a consensus meeting will be held for the latter issue) – they will be in charge of collecting data for their own countries 4.3 – A highly decentralized country as a natural experiment: Italy

– Replication of the analysis in other European countries Objectives By replicating the analysis carried out for Italy (task 4.3), test the empirical relevance of the impact of the different characteristics of health care systems on the incentives attributed to prospective payment systems, in other European countries (Denmark and UK) Methodology Alongside the guidelines elaborated within 4.3

16  Output Report (part 2) on the empirical analysis of the effects of the use of a prospective payment system in the Italian, Danish and UK hospital care sector (D – part of D 4.1 “Report on financing hospital care”)  Timing Start: June 2012 – End: January 2013  Partners SDU and UY will perform the analysis, respectively for Denmark and UK 4.4 – Replication of the analysis in other European countries

– Policy analysis  Objectives Characterization of the effects of prospective payment systems, in terms of relevant characteristics of health care systems Define policy implications, in terms of design and fine tuning of financing systems for hospital care, once the peculiarities of health care systems are taken into account

18  Methodology Comparative analysis of the results of empirical studies for the different countries  Output Report on “Recommended financing models for hospital care” (D 4.2)  Timing Start: February 2013 – End: June 2013  Partners SDU and UY will be involved in the comparative analysis and in a consensus meeting to discuss a first draft of D – Policy analysis

19 Collaborative work of WP4 Collaborative work for WP1: –Integration of the literature review on payment mechanisms for hospital care, particularly DRG, to take into account italian literature and papers not consistent with the systematic review criteria Collaborative work for WP2: –Cooperation on the chapter on efficiency, to review the relevant notions of efficiency and the techniques for measuring efficiency