부산대학교 도서관

This thesis consists of three empirical essays, contributing to the understanding of key policy issues related to financial incentives in the healthcare setting. Chapters 2 and 3 con- tribute to a growing literature on the Pay for Performance (P4P) schemes in the secondary care, while Chapter 4 focuses on the design of the prospective payment reimbursement system. Chapter 2 evaluates the impact of a financial incentive, designed to improve care of fragility hip fracture patients in England and implemented in 2010. The scheme adopts a bundled approach, by which nine different criteria related to quality of care must be met in order for the hospitals to receive bonus payment. Analysis is based on the difference-in- difference framework, with Wales as a control group. Results show large and statistically significant effect of the scheme on the uptake of the incentivised quality measures. Effects on patients mortality are small and mostly insignificant. Chapter 3 considers a financial incentive scheme designed to shift inpatient activity to outpatient setting and implemented in England in 2012. The scheme targets three condi- tions and operates by overpaying the outpatient activity while concurrently underpaying inpatient activity. Using difference-in-difference approach, the results indicate large and significant effects of the policy on increasing the proportion of patients treated in the out- patient setting, without harming the quality of care or increasing the overall volume of activity. Chapter 4 estimates the effect of a Diagnosis Related Groups (DRG) classification re- form on hospitals' coding behaviour. The chapter considers a major reform in English DRG system in 2009 which highlighted the role of reported comorbidities in the reimbursement process. The analysis is based on the difference-in-difference framework. Results indi- cate significant effect of the reform on coding intensity, increasing the probability of being coded to a severe HRG and, consequently, the overall treatment cost.