Paying for efficiency: Incentivising same-day discharges in the English NHS

Posted on 28 August 2018

CHE's latest Research Paper 157 written by James Gaughan, Nils Gutacker, Katja Grasic, Noemi Kreif, Luigi Siciliani and Andrew Street

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In the latest CHE Research Paper 157, Gaughan et al evaluate a pay-for-efficiency scheme that encourages hospitals to admit and discharge patients on the same calendar day where clinically appropriate. Since 2010, hospitals in the English NHS receive a higher price for patients treated as same-day discharge than for overnight stays, despite the former being less costly. Gaughan et al analyse administrative data for patients treated for 191 conditions for which same-day discharge is clinically appropriate — of which 32 are incentivised — during 2006-2014. Using interrupted time series, differences-in-differences and synthetic control methods, they find that the policy generally had a positive effect on planned conditions with a statistically significant effect in about a third of conditions. The results are more mixed for emergency conditions. Condition-specific design features such as the average profit margin explain some, but not all, of the differential responses.

Full Report: CHE Research Paper 157 (PDF , 2,139kb)

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