The effects of competition and bundled payment on patient reported outcome measures after hip replacement surgery

BMC Health Services Research

Clas Rehnberg¹  Fanny Goude²  Maziar Mohaddes³  Henrik Malchau⁴  Sverre A. C. Kittelsen⁵ 

[1] Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18A, 17177, Stockholm, Sweden;Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18A, 17177, Stockholm, Sweden;Centre for Health Economics, Informatics and Health Services Research, Stockholm Health Care Services, Region Stockholm, Tomtebodavägen 18A, 17177, Stockholm, Sweden;Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg university, Medicinaregatan 3, 41390, Göteborg, Sweden;Swedish Hip Arthroplasty Register, Centre of Registers Västra Götaland, Medicinaregatan 18 G, 41345, Göteborg, Sweden;Department of Orthopaedics, Sahlgrenska University Hospital, Göteborgsvägen 31, 431 80, Mölndal, Sweden;Department of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 02114, Boston, MA, USA;Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg university, Medicinaregatan 3, 41390, Göteborg, Sweden;Swedish Hip Arthroplasty Register, Centre of Registers Västra Götaland, Medicinaregatan 18 G, 41345, Göteborg, Sweden;Department of Orthopaedics, Sahlgrenska University Hospital, Göteborgsvägen 31, 431 80, Mölndal, Sweden;Frisch Centre, Gaustadalléen 21, 0349, Oslo, Norway;

关键词: Patient reported outcome measures;    Competition;    Bundled payment;    Quality;    Difference-in-difference analysis;    Total hip replacement;    Entropy balancing;    Patient choice;    Economic incentives;    Propensity scores;   

DOI  :  10.1186/s12913-021-06397-1

来源: Springer

【 摘 要 】

BackgroundCompetition-promoting reforms and economic incentives are increasingly being introduced worldwide to improve the performance of healthcare delivery. This study considers such a reform which was initiated in 2009 for elective hip replacement surgery in Stockholm, Sweden. The reform involved patient choice of provider, free establishment of new providers and a bundled payment model. The study aimed to examine its effects on hip replacement surgery quality as captured by patient reported outcome measures (PROMs) of health gain (as indicated by the EQ-5D index and a visual analogue scale (VAS)), pain reduction (VAS) and patient satisfaction (VAS) one and six years after the surgery.MethodsUsing patient-level data collected from multiple national registers, we applied a quasi-experimental research design. Data were collected for elective primary total hip replacements that were carried out between 2008 and 2012, and contain information on patient demography, the surgery and PROMs at baseline and at one- and six-years follow-up. In total, 36,627 observations were included in the analysis. First, entropy balancing was applied in order to reduce differences in observable characteristics between treatment groups. Second, difference-in-difference analyses were conducted to eliminate unobserved time-invariant differences between treatment groups and to estimate the causal treatment effects.ResultsThe entropy balancing was successful in creating balance in all covariates between treatment groups. No significant effects of the reform were found on any of the included PROMs at one- and six-years follow-up. The sensitivity analyses showed that the results were robust.ConclusionsCompetition and bundled payment had no effects on the quality of hip replacement surgery as captured by post-surgery PROMs of health gain, pain reduction and patient satisfaction. The study provides important insights to the limited knowledge on the effects of competition and economic incentives on PROMs.

【 授权许可】

CC BY