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Efficiency improvements of public hospitals under a capitation payment scheme

Published online by Cambridge University Press:  24 January 2013

Javier García-Lacalle  and
Emilio Martín
Javier García-Lacalle*
Affiliation:
Department of Accounting and Finance, Faculty of Economics and Business Administration, University of Zaragoza, Zaragoza, Spain
Emilio Martín
Affiliation:
Department of Accounting and Finance, Faculty of Economics and Business Administration, University of Zaragoza, Zaragoza, Spain
*
*Correspondence to: Javier García-Lacalle, Department of Accounting and Finance, Faculty of Economics and Business Administration, University of Zaragoza, Gran Vía 2, 50005 Zaragoza, Spain. E-mail: jlacalle@unizar.es
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Abstract

In a context of cost containment and demands for better quality in public health care, payment systems are used as an instrument to promote efficiency improvements in service providers. Andalusia has adopted an original type of risk-adjusted capitation payment mechanism to reimburse public hospitals. This paper presents the main characteristics of the reimbursement mechanism of the Andalusian Health Service highlighting some differences with the mechanisms adopted in other parts of Europe. The paper also explores the evolution of the efficiency and quality of the hospitals after its implementation using the Malmquist index. Results indicate that hospitals have slightly improved their efficiency, particularly urban hospitals, and these improvements are not significantly related to a negative evolution of quality. However, it is not possible to assert to what extent, improvements are the consequence of the new payment system. The organisation of the Servicio Andaluz de Salud and the limited competition between hospitals reduce the effectiveness of the reform.

Type
Articles
Information
Health Economics, Policy and Law , Volume 8 , Issue 3 , July 2013 , pp. 335 - 364
Copyright
Copyright © Cambridge University Press 2013 

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