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Quality of Care Unchanged Under New Payment System

Last Updated: August 28, 2009.

The implementation of a fixed-price, payment-by-results system for hospitals in the United Kingdom, beginning in 2002, has reduced the length of hospital stays and increased day case (outpatient) admissions, but has had no measurable effect on quality of care, according to a study published Aug. 27 in BMJ.

FRIDAY, Aug. 28 (HealthDay News) -- The implementation of a fixed-price, payment-by-results system for hospitals in the United Kingdom, beginning in 2002, has reduced the length of hospital stays and increased day case (outpatient) admissions, but has had no measurable effect on quality of care, according to a study published Aug. 27 in BMJ.

Shelley Farrar, Ph.D., of the University of Aberdeen in the United Kingdom, and colleagues analyzed hospital and morbidity statistics for trusts in England, where the payment system was implemented, and providers in Scotland, where it was not, to see if the payment system was associated with changes in hospital volume, cost, or quality of care.

The researchers found that, where the payment-by-results system was implemented, hospital length of stay fell and the proportion of day case admissions increased, suggesting a drop in unit cost. There also was some equivocal evidence that the number of hospital stays increased, however, the researchers found insignificant changes in the quality of care attributable to the payment-by-results system.

"With respect to quality of care, the evidence should be treated with caution because, in common with other researchers, we were limited by the availability of proxies for the complexity that is 'quality' of health care. Our results suggest that the reductions in unit costs have been achieved without a detrimental impact on the quality of care, at least in as far as these are measured by our proxy variables," the authors write.

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