Changes in hospital performance after implementation of pay-for-performance in Japan
Yusuke Inoue, Seungwon Jeong, Katsunori Kondo
Nihon Fukushi University, Chiyoda, Nakaku, Nagoya, Japan
Background: The purpose of this study was to evaluate the effect of pay-for-performance (P4P) in hospitals in Japan, and to determine if any improvement occurred in the Functional Independence Measure (FIM™) score at the time of discharge from hospital, the return home rate, and whether there was any intentional selection by hospitals of patients expected to have greater recovery.
Methods: We used the data produced by the Rehabilitation Patients DataBank of Japan (February 2011, for 903 patients and 26 hospitals), and identified patient characteristics and processes (by t-test and Chi-square test), change in FIM score on discharge from hospital (by regression analysis), and change in return home rate (by logistic regression analysis) before and after the implementation of P4P.
Results: Given the high FIM scores at admission and discharge after P4P was introduced, as well as the high return home rate, the possibility of an intentional increase in the number of patients whose conditions would be easily improved could not be excluded, although this could not be construed as the definite result of a patient screening practice. In addition, following the implementation of P4P, there was improvement in the process by which health care delivery was provided, but neither the FIM gain nor the return home rate was significantly higher after P4P was introduced. A similar result was obtained when the data were analyzed only by hospital cases for the entire period before and after P4P implementation.
Conclusion: No effect of P4P implementation on FIM at discharge or the return home rate was observed in this study. In the future, continuous monitoring of changes after implementation of P4P and detailed analysis of the possibility of deliberate patient screening will be needed. A more indepth examination of the indicators and incentive criteria currently in use is recommended.
Keywords: pay for performance, Functional Independence Measure, improvement, return home rate, Rehabilitation Patients DataBank of Japan
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