Publication: Purchasing Inpatient and Outpatient Care through Hospitals
Date
2004-09
ISSN
Published
2004-09
Author(s)
de Roodenbeke, Eric
Abstract
After considering the fulfillment of
some basic criteria making purchasing a tool for
effectiveness, a framework allows to review how to best buy
hospital services. Who should benefit most from hospital
care financing ? The answer to this question will rely on an
investigation of hospital services utilization, and on a
better understanding of patients profiles. This type of
investigation is a baseline for further decisions on what to
buy. A purchaser should wonder: to what public health
priorities hospital responds best and how efficient and
equitable is hospital care? But hospitals have also a unique
role in helping people facing major hazards, in providing
some essential public health services and in enabling
training: these services should be considered when
purchasing. Hospitals represent a large diversity of
organizations. Having that in mind makes it easier to figure
out from whom to buy. The potential provision of care
depends on the level of the provider but is also related to
hospitals status taking into consideration productivity. It
is also worthwhile to investigate insurance's role in
the provision of care. Payment mechanisms have a strong
influence on performance, for that reason the major
alternative schemes have to be considered, each of them
having advantages and limits. But hospital cash flow is also
a specific issue that should not be ignored. The price paid
has to be determined before making an agreement. This should
lead to cautious estimates of cost of services as the
information systems are often weak. Moreover it might be
worthwhile to play with margin to favor internal cross
subsidies. The co-payments as well as the opportunity cost
have to be included to understand how to get best from
pricing. Dealing with subsidies is a cornerstone when
seeking better performance while purchasing hospital
services. How subsidies are going to be channeled and for
what kind of services will determine if purchasing is really effective.
Citation
“de Roodenbeke, Eric. 2004. Purchasing Inpatient and Outpatient Care through Hospitals. Health, Nutrition and Population (HNP)
discussion paper;. © World Bank, Washington, DC. http://openknowledge.worldbank.org/entities/publication/48e0ae6c-67dc-5704-82ff-7148de98d9ed License: CC BY 3.0 IGO.”