Impact of global budget combined with pay-for-performance on the quality of care in county hospitals: a difference-in-differences study design with a propensity-score-matched control group using data from Guizhou province, China

BMC Health Services Research

Zhifan Wang¹  Weiyan Jian¹  Wuping Zhou¹  Winnie Yip²  Min Hu³  Jay Pan⁴ 

[1] Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China;Harvard School of Public Health, Boston, MA, USA;School of Public Health, Fudan University, Shanghai, China;West China Research Center for Rural Health Development, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China;

关键词: Global budget;    Process quality;    County hospitals;    Inpatient;    China;   

DOI  :  10.1186/s12913-021-07338-8

来源: Springer

【 摘 要 】

BackgroundProvider payment system has a profound impact on health system performance. In 2016, a number of counties in rural Guizhou, China, implemented global budget (GB) for county hospitals with quality control measures. The aim of this study is to measure the impact of GB combined with pay-for-performance on the quality of care of inpatients in county-level hospitals in China.MethodsInpatient cases of four diseases, including pneumonia, chronic asthma, acute myocardial infarction and stroke, from 16 county-level hospitals in Guizhou province that implemented GB in 2016 were selected as the intervention group, and similar inpatient cases from 10 county-level hospitals that still implemented fee-for-services were used as the control group. Propensity matching score (PSM) was used for data matching to control for age factors, and difference-in-differences (DID) models were constructed using the matched samples to perform regression analysis on quality of care for the four diseases.ResultsAfter the implementation of GB, rate of sputum culture in patients with pneumonia, rate of aspirin at discharge, rate of discharge with β-blocker and rate of smoking cessation advice in patients with acute myocardial infarction increased. Rate of oxygenation index assessment in patient with chronic asthma decreased 20.3%. There are no significant changes in other indicators of process quality.ConclusionsThe inclusion of pay-for-performance in the global budget payment system will help to reduce the quality risks associated with the reform of the payment system and improve the quality of care. Future reform should also consider the inclusion of the pay-for-performance mechanism.

【 授权许可】

CC BY