Economics Research Community Seminar – Dr Rita Santos
Title: Payment reform, purchaser and provider decisions and the performance of emergency healthcare systems.
Date: 11 October 2023
Time: 13:00-14:00
Location: NUBS.4.25
Speaker: Rita Santos
If you would like to attend, please register using the following link:
Rita Santos is a Senior Research Fellow at the Centre for Health Economics of the University of York since 2009. She recently finished her NIHR doctoral research fellowship on ‘Measuring and explaining primary care quality variation’. In the past years, she worked on GP gender pay differences, GP practice choice, hospital competition and GP practices competition. Her main interests are developing applications of geographical information system to health economics and spatial econometric methods to health economics and economic theory. Rita holds a BA in Economics and an MSc in Applied Economics from the Faculty of Economics, University of Coimbra. She worked at the Department of Geography, University of Coimbra (2004-2009) where she developed research on environmental impacts on health outcomes.
Abstract
The way the NHS pays providers of emergency healthcare has been changing with an increasing emphasis on what is called blended payment. This means there is discretion to move away from nationally set prices and ‘blend’ activity-based payments with a fixed payment element. We employ a combination of theoretical modelling and empirical investigations to shed light on this complex issue. We start by developing a theoretical model that explores how changes in payment methods affect the behaviour of key players: Purchasers – Clinical Commissioning Groups (CCGs) -and Providers – NHS Hospital Trusts. Our model is unique in that it considers the varying willingness of CCGs to put in extra effort to reduce visits to Accident and Emergency (A&E) Departments and purchasers to reduce emergency admissions. Two empirical investigations form the core of our study: (1) variation in the propensity to admit patients from A&E departments across NHS hospital Trusts and (2) variation in A&E attendance rates across Clinical Commissioning Groups (CCGs). Our research reveals that (1) hospitals exhibit wide variation in admission propensity (a mean of 0.20 and standard deviation of 0.40), even after accounting for patient differences; (2) the A&E attendance rates vary widely across CCGs (from less than 10 to more than 50 A&E attendances per 1000 population) even after considering GP practice and area-level characteristics. This implies that the impact of payment reform will not be uniform across hospitals and CCGs. In conclusion, our study offers valuable insights into the complex interplay between payment reform, hospital behaviour, and healthcare purchaser disparities in emergency healthcare utilisation. It provides a foundation for understanding how different stakeholders respond to changes in payment methods within the NHS, shedding light on the multifaceted nature of healthcare reform.