Abstract
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.
Highlights
Provider payment system has a profound impact on health system performance
Full list of author information is available at the end of the article
In order to clearly define the quality of care, based on previous studies, we have identified four diseases for which there are clear guidelines for treatment and necessary medical services, which were: acute myocardial infarction, stroke, pneumonia, and chronic asthma
Summary
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. Provider payment system has a profound impact on health system performance. In 2016, a number of counties in rural Guizhou, China, implemented the provider payment reform, changing from FFS to global budget (GB), in the hope of reducing the growth rate of healthcare costs. At the beginning of every year, the county hospitals’ total annual budgets were set based on the types of diseases they can treat, the number of hospitalizations and the average cost for each type of disease in the previous year. The relative size of the performance payment was based on practice in other parts of China and other country, and this ratio had been shown to produce good results [2,3,4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
