A Systematic Review of the Association Between Hospital Cost/price and the Quality of Care
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SYSTEMATIC REVIEW
A Systematic Review of the Association Between Hospital Cost/price and the Quality of Care Sara Jamalabadi1 · Vera Winter1,2 · Jonas Schreyögg1
© The Author(s) 2020
Abstract Background Limited empirical evidence exists regarding the effect of price changes on hospital behavior and, ultimately, the quality of care. Additionally, an overview of the results of prior literature is lacking. Objective This study aims to provide a synthesis of existing research concerning the relationship between hospital cost/ price and the quality of care. Methods Searches for literature related to the effect of hospital cost and price on the quality of care, including studies published between 1990 and March 2019, were carried out using four electronic databases. In total, 47 studies were identified, and the data were extracted and summarized in different tables to identify the patterns of the relationships between hospital costs/prices and the quality of care. Results The study findings are highly heterogenous. The proportion of studies detecting a significant positive association between price/cost and the quality of care is higher when (a) price/reimbursement is used (instead of cost); (b) process measures are used (instead of outcome measures); (c) the focus is on acute myocardial infarction, congestive heart failure, and stroke patients (instead of patients with other clinical conditions or all patients); and (d) the methodological approach used to address confounding is more sophisticated. Conclusion Our results suggest that there is no general relationship between cost/price and the quality of care. However, the relationship seems to depend on the condition and specific resource utilization. Policy makers should be prudent with the measures used to reduce hospital costs to avoid endangering the quality of care, especially in resource-sensitive settings.
1 Introduction Providing high-quality healthcare services at a reasonable cost is among the main policy goals in many countries [1]. In recent decades, hospital reimbursement systems have undergone substantial revisions in many countries to reduce spending and increase the quality of care. Hence, hospital prices have been subject to changes. In general, hospital pricing mechanisms range from fee-for-service price lists
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40258-020-00577-6) contains supplementary material, which is available to authorized users. * Vera Winter [email protected]‑wuppertal.de 1
Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany
Schumpeter School of Business and Economics, University of Wuppertal, Rainer‑Gruenter‑Str. 21, 42119 Wuppertal, Germany
2
to global budgets, and diagnosis-related group (DRG) payments have spread across numerous countries [2]. DRG systems in various countries often rely on hospitals’ cost information and are subject to changes over time. Theoretical works predict that increasing DRG prices provides incentives for hospita
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