RT Dissertation/Thesis
T1 Incentives in health care provision
A1 Weinert,Johanna Katharina
WP 2024/01/02
AB The importance of finding ways to ensure high quality health care provision in a cost-effective and  efficient way becomes a more and more pressing issue considering the challenges many economies currently face due to ageing populations, rising costs caused by advancements in medical technology or an increasing shortage in qualified personnel. 
Chapter 2 analyzes empirically how the introduction of a surgical suite governance document affects punctuality in first case of the day starts. Delays in first cases are an indicator for inefficiencies in operating room utilization. Because operating rooms constitute a major driver in hospitals’ operating costs, clinic management has a strong interest in incentivizing process efficiency. This analysis focuses on the implementation of a surgical suite governance document, which explicitly specifies the starting time of the first case of the day and formulates scheduling rules. First case punctuality is an easily observable and measurable performance indicator, which is associated with only minor tracking efforts and consequently low costs. The analysis uses a quasi-experimental setting, which arose from the lagged implementation of an identical governance document in two different hospital sites belonging to the same hospital group. To assess the effect of the governance document empirically , a difference-in-difference estimation approach is implemented. Results indicate that the introduction of a surgical suite governance document is associated with significant reductions in first case delays. In conclusion, a surgical suite governance document seems to offer a promising tool to incentivize health care workers to use costly resources like surgery capacities more efficiently.
Chapter 3 analyzes the effects of a reimbursement change - from fee-for-service paid out-of-pocket (OOP-FFS) to a capitation fee per patient - on health service provision. This change was part of a selective contract in outpatient pediatric care introduced by a large German sickness fund in 2014. The present analysis aims at deriving further insights on how reimbursement affects service provision and at offering guidelines for future designs of selective contracts. To reflect the special features of the analyzed selective contract, namely that incentives change for both the pediatricians and the patients simultaneously, a theoretical model is set up to derive a testable hypothesis. The model predicts that given pediatricians are not only monetarily incentivized (but also sufficiently concerned about patients’ well-being) and that costs associated with screening provision are relatively small, reimbursement change from OOP-FFS to capitation will induce an increase in service provision. Using a generalized difference-in-difference approach, the theoretically derived hypothesis is tested empirically. Results indicate that the change from fee-for-service paid out-of-pocket to a capitation fee per patient did lead to a significant increase in provided screenings as the number of diagnoses more than doubles for pediatricians enrolled in the program. These findings indicate that physicians are not solely driven by monetary incentives and that capitation per patient offers a valuable tool to ensure cost control yet simultaneously ensure effective health care provision.  
Chapter 4 examines to which extent policymakers are able to incentivize hospitals to increase quality provision by actively fostering the link between performance indicator reporting and hospitals’ reputation. A better understanding of policymakers influence on quality incentives is crucial as empirical findings show that hospitals vary with respect to quality provision, implying that potential for improvements exists at least for some service providers. By fostering the link between hospitals’ outcome-based performance indicators such as mortality-, readmission- or complication rates and reputation, policymakers are able to affect hospitals’ market share and thereby ultimately hospitals’ incentives for quality provision. Ways to strengthen the aforementioned link are manifold, e.g. by raising awareness about the existence and importance of hospital performance reports or by improving populations’ health literacy to ensure that patients are able to decode the information provided by performance indicators correctly. The main finding is that a strengthened link between performance indicators’ realization and hospitals’ reputation does not necessarily result in stronger incentives for quality provision. In the case where the degree of competition is sufficiently low and the costs associated with quality provision are sufficiently high, an intensified link between performance indicators and reputation induces a decrease in quality provision. If the opposite is true, strengthening the link between performance indicators’ realization and hospitals’ reputation always induces an increase in quality provision.

K1 Gesundheitsökonomie
K1 Medizinische Versorgung
K1 Vorsorge
PP Hohenheim
PB Kommunikations-, Informations- und Medienzentrum der Universität Hohenheim
UL http://opus.uni-hohenheim.de/volltexte/2024/2257