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Work package 4 Hospital care

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

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Work package 4 Hospital care

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  1. Work package 4Hospital 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 InterQuality kick-off meeting Warsaw 18-19 January 2011

  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 InterQuality kick-off meeting Warsaw 18-19 January 2011

  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 InterQuality kick-off meeting Warsaw 18-19 January 2011

  5. 4.1 - 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 InterQuality kick-off meeting Warsaw 18-19 January 2011

  6. 4.1 - Comparative analysis of European reimbursement systems for hospital care • 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 • Output Report on the implementation of prospective payment systems in the hospital care sector in Denmark, Italy and UK (D 4.1.1) • Timing Start: June 2011 - End: December 2012 • Partners SDU and UY, as for the description of the payment system in their countries – comparative analysis is the main responsibility of UniCT InterQuality kick-off meeting Warsaw 18-19 January 2011

  7. 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 InterQuality kick-off meeting Warsaw 18-19 January 2011

  8. 4.2 – Prospective payment systems and characteristics of health care systems • 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 InterQuality kick-off meeting Warsaw 18-19 January 2011

  9. 4.2 – Prospective payment systems and characteristics of health care systems • 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) InterQuality kick-off meeting Warsaw 18-19 January 2011

  10. 4.2 – Prospective payment systems and characteristics of health care systems • Output Report on the effects of prospective payment systems as related to important characteristics of health care provision (D 4.1.2 – part of D 4.1 Report on financing hospital care) • Timing Start: January 2012 – End: June 2012 • Partners The task will be mainly performed by WP leader. The framework of analysis will be mainly discussed with SDU and UY, and also with UI, because of its responsibility within WP1 – Results presented at a consensus meeting InterQuality kick-off meeting Warsaw 18-19 January 2011

  11. 4.3 – 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 InterQuality kick-off meeting Warsaw 18-19 January 2011

  12. 4.3 – A highly decentralized country as a natural experiment: Italy • 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 InterQuality kick-off meeting Warsaw 18-19 January 2011

  13. 4.3 – A highly decentralized country as a natural experiment: Italy • 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 4.1.3 – 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 InterQuality kick-off meeting Warsaw 18-19 January 2011

  14. 4.4 – 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 InterQuality kick-off meeting Warsaw 18-19 January 2011

  15. 4.4 – Replication of the analysis in other European countries • 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 4.1.3 – part of D 4.1 “Report on financing hospital care”) • Timing Start: November 2012 – End: May 2013 • Partners SDU and UY will perform the analysis, respectively for Denamrk and UK InterQuality kick-off meeting Warsaw 18-19 January 2011

  16. 4.5 – 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 InterQuality kick-off meeting Warsaw 18-19 January 2011

  17. 4.5 – Policy analysis • 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: March 2013 – End: August 2013 • Partners SDU and UY will be involved in the comparative analysis and in a consensus meeting to discuss a first draft of D 4.2 InterQuality kick-off meeting Warsaw 18-19 January 2011

  18. Collaborative work • Collaborative work specifically envisaged with SDU and UY, alongside the lines identified in each task • Collaborative work with CPME and EPF, mainly for dissemination strategy as related to their specific experience InterQuality kick-off meeting Warsaw 18-19 January 2011

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