Do prospective payment systems (PPSs) lead to desirable providers’ incentives and patients’ outcomes? A systematic review of evidence from developing countries

The reform of provider payment systems, from retrospective to prospective payment, has been heralded as the right move to contain costs in the light of rising health expenditures in many countries. However, there are concerns on quality trade-off. The heightened attention given to prospective payment system (PPS) reforms and the rise of empirical evidence regarding PPS interventions among developing countries suggest that a systematic review is necessary to understand the effects of PPS reforms in developing countries. A systematic search of 14 databases and a hand search of health policy journals and grey literature from October to November 2016 were carried out, guided by a set of inclusion and exclusion criteria. Data were extracted based on the Consolidated Health Economics Evaluation Reporting Standards checklist. Drummond's 10-item checklist for economic evaluation, Cochrane Collaboration's tool in assessing risk of bias for randomized trials, and Risk of Bias in Non-randomized Studies of Interventions were used to critically appraise the evidence. A total of 12 studies reported in China, Thailand and Vietnam were included in this review. Substantial heterogeneity was present in PPS policy design across different localities. PPS interventions were found to have reduced health expenditures on both the supply and demand side, as well as length of stay and readmission rates. In addition, PPS generally improved service quality outcomes by reducing the likelihood or percentage of physicians prescribing unnecessary drugs and diagnostic procedures. PPS is a promising policy tool for middle-income countries to achieve reasonable health policy objectives in terms of cost containment without necessarily compromising the quality of care. More evaluations of PPS will need to be conducted in the future in order to broaden the evidence base beyond middle-income countries.

[1]  A. Mills,et al.  Patient satisfaction in Bangkok: the impact of hospital ownership and patient payment status. , 1999, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[2]  R. Ellis,et al.  Provider Payment Methods and Incentives , 2015 .

[3]  G. Mead,et al.  Physical fitness training for stroke patients. , 2009, The Cochrane database of systematic reviews.

[4]  Å. Blomqvist,et al.  How to Pay Family Doctors: Why 'Pay Per Patient' Is Better than Fee for Service , 2012 .

[5]  C. Dubois,et al.  Human Resources for Health Human Resources for Health Policies: a Critical Component in Health Policies , 2022 .

[6]  A. Mills,et al.  Health Services in Low- and Middle-Income Countries: Financing, Payment, and Provision , 2014 .

[7]  Gordon Liu,et al.  Payment reform and changes in health care in China. , 2014, Social science & medicine.

[8]  R. Devlin,et al.  Does the way physicians are paid influence the way they practice? The case of Canadian family physicians' work activity. , 2010, Health policy.

[9]  B. James,et al.  The Case for Capitation. , 2016, Harvard business review.

[10]  P. Hanvoravongchai,et al.  Thailand: Achieving Universal Coverage with Social Health Insurance , 2007 .

[11]  A. Wagstaff,et al.  The Impact of a Pay-for-Performance Scheme on Prescription Quality in Rural China: An Impact Evaluation , 2014, Health economics.

[12]  V. Fan,et al.  Global Budget Payment , 2016, Inquiry : a journal of medical care organization, provision and financing.

[13]  Hong Wang,et al.  An experiment in payment reform for doctors in rural China reduced some unnecessary care but did not lower total costs. , 2011, Health affairs.

[14]  W. Yip,et al.  Payment Reform Pilot In Beijing Hospitals Reduced Expenditures And Out-Of-Pocket Payments Per Admission. , 2015, Health affairs.

[15]  G. Carrin,et al.  Provider payments and patient charges as policy tools for cost-containment: How successful are they in high-income countries? , 2003, Human resources for health.

[16]  A. Wagstaff,et al.  Getting Incentives Right? The Impact of Hospital Capitation Payment in Vietnam , 2017, Health economics.

[17]  Peter C. Smith,et al.  The Oxford Handbook of Health Economics , 2013 .

[18]  L. Casalino,et al.  Effects of Health Care Payment Models on Physician Practice in the United States. , 2015, Rand health quarterly.

[19]  S. Ratanawijitrasin,et al.  Does your health care depend on how your insurer pays providers? Variation in utilization and outcomes in Thailand , 2009, International Journal of Health Care Finance and Economics.

[20]  Anthony J. Culyer,et al.  Consolidated Health Economic Evaluation Reporting Standards , 2014 .

[21]  A. Mills,et al.  The response of providers to capitation payment: a case-study from Thailand. , 2000, Health policy.

[22]  Bruce Landon,et al.  Paying for quality: providers' incentives for quality improvement. , 2004, Health affairs.

[23]  D. Conrad.  The Theory of Value‐Based Payment Incentives and Their Application to Health Care , 2015, Health services research.

[24]  K. Eggleston,et al.  Health Care for 1.3 Billion: An Overview of China’s Health System , 2012 .

[25]  Kari L. Hurt,et al.  Moving toward Universal Coverage of Social Health Insurance in Vietnam: Assessment and Options , 2014 .

[26]  M. Hernán,et al.  ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions , 2016, British Medical Journal.

[27]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement , 2009, BMJ.

[28]  D. Rodrik.  Why We Learn Nothing from Regressing Economic Growth on Policies , 2012 .

[29]  L. Steuten,et al.  A Systematic Review of Health Economic Evaluations of Diagnostic Biomarkers , 2015, Applied Health Economics and Health Policy.

[30]  B. B. Tai,et al.  A Systematic Review of Health Economic Evaluation Studies Using the Patient's Perspective. , 2016, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[31]  A. Wagstaff,et al.  System-Wide Impacts of Hospital Payment Reforms: Evidence from Central and Eastern Europe and Central Asia , 2009, Journal of health economics.

[32]  Willem Gilles,et al.  A typology for provider payment systems in health care. , 2002, Health policy.

[33]  Soonman Kwon,et al.  Payment system reform for health care providers in Korea. , 2003, Health policy and planning.

[34]  J. Popay,et al.  Guidance on the conduct of narrative synthesis in sytematic reviews , 2006 .

[35]  K. Eggleston,et al.  Addressing government and market failures with payment incentives: Hospital reimbursement reform in Hainan, China. , 2004, Social science & medicine.

[36]  Effects of DRG-based hospital payment in Poland on treatment of patients with stroke. , 2015, Health policy.

[37]  Elena Parmelli,et al.  An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes. , 2011, The Cochrane database of systematic reviews.

[38]  Elizabeth Manias,et al.  Patients’ and family members’ views on how clinicians enact and how they should enact incident disclosure: the “100 patient stories” qualitative study , 2011, BMJ : British Medical Journal.

[39]  A. Culyer.  THE NORMATIVE ECONOMICS OF HEALTH CARE FINANCE AND PROVISION , 1989 .

[40]  B Leese,et al.  Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians. , 2000, The Cochrane database of systematic reviews.

[41]  William Hsiao,et al.  Realignment of incentives for health-care providers in China , 2010, The Lancet.

[42]  K. Eggleston,et al.  Provider payment reform in China: the case of hospital reimbursement in Hainan province. , 2001, Health economics.

[43]  Shou-Hsia Cheng,et al.  The impacts of DRG-based payments on health care provider behaviors under a universal coverage system: a population-based study. , 2012, Health policy.

[44]  Sangil Lee,et al.  Effects of the DRG-based prospective payment system operated by the voluntarily participating providers on the cesarean section rates in Korea. , 2007, Health policy.

[45]  J. Bryant,et al.  Payment mechanisms and prescriptions in four Thai hospitals. , 2005, Health policy.

[46]  M. Campbell,et al.  CONSORT 2010 statement: extension to randomised pilot and feasibility trials , 2016, British Medical Journal.

[47]  Jennie Popay,et al.  Guidance on the conduct of narrative synthesis in systematic Reviews. A Product from the ESRC Methods Programme. Version 1 , 2006 .

[48]  Cheryl Cashin,et al.  Designing and implementing health care provider payment systems : how-to manuals , 2009 .

[49]  R. Bitrán,et al.  A review of health care provider payment reform in selected countries in Asia and Latin America. , 1998 .

[50]  Simon Shepherd,et al.  Screening programmes for the early detection and prevention of oral cancer. , 2013, The Cochrane database of systematic reviews.

[51]  Marc J. Roberts,et al.  Getting Health Reform Right: A Guide to Improving Performance and Equity , 2003 .

[52]  A. Culyer.  Encyclopedia of health economics , 2014 .

[53]  A. Glenny,et al.  The effect of different methods of remuneration on the behaviour of primary care dentists. , 2013, The Cochrane database of systematic reviews.

[54]  W. Hsiao,et al.  Social Health Insurance For Developing Nations , 2007 .

[55]  M. Porter,et al.  How to Pay for Health Care. , 2016, Harvard business review.

[56]  M. Drummond,et al.  Health Care Technology: Effectiveness, Efficiency and Public Policy@@@Methods for the Economic Evaluation of Health Care Programmes , 1988 .

[57]  J. Sterne,et al.  The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials , 2011, BMJ : British Medical Journal.

[58]  J. Christianson,et al.  Provider Payment and Incentives , 2011 .

[59]  W. Hsiao,et al.  Capitation combined with pay-for-performance improves antibiotic prescribing practices in rural China. , 2014, Health affairs.

[60]  R. Sauerborn,et al.  Provider payment in community-based health insurance schemes in developing countries: a systematic review , 2012, Health policy and planning.