Langenbrunner JC, Sheiman I.
AHSR FHSR Annu Meet Abstr Book. 1995; 12: 121-2.
Abt Associates, Moscow, Russia.
PROBLEMS AND OBJECTIVES. The health care sector of the former Soviet Union (FSU) suffers from too many specialists, over-emphasis on inpatient care and few or no incentives for improving outcomes. A number of republics and geographic areas have begun experimenting with new methods of incentive payments for providers and management of health care services generally. This paper provides the results of an evaluation of a new payment demonstration in one oblast (the geo-political equivalent of a state) of one of the new Central Asian republics of Kazakhstan. Small family practice groups composed of primary care subspecialists were formed out of the former polyclinic structure. These groups received per capita payments and were placed at risk for all inpatient and outpatient services. Hospitals, in turn, received a per case payment based on diagnosis and adjusted by the length of stay. DATA AND METHODS. Two types of efficiency were broadly measured using a range of indicators--allocative efficiency, or use of funds across settings; and technical efficiency, or the use of funds within specific provider settings such as a polyclinic or hospital. Pre-post and time series data for a range of variables were analyzed; these data and results were compared with trends in other oblasts and nationally. RESULTS AND CONCLUSIONS. New incentives, mostly related to primary care fundholding, point to structural changes that have increased allocative efficiency and, in general, more cost-effective provision of care. For example, the ratio of general practitioners to specialists improved from 1:5.2 to 1:3; the share of visits to primary care physicians improved from 37 to 51 percent. But some preventive services decreased. Results pertaining to technical efficiency were more mixed. Hospital admissions declined by 26 percent and the number of patient days decreased. However, lengths-of-stay (after adjusting for case-mix) remained stable and overall hospital productivity declined. IMPLICATIONS FOR AUDIENCE. The FSU countries and the U.S. face similar issues related to underprovision of primary and preventive care and the mix of specialists relative to primary care physicians. This demonstration evaluation provides insight on alternative organizational models and approaches that promote primary care. Evidence is provided on the impacts of new incentives on the provision of different types of services.
Publication Types:
Keywords:
- Ambulatory Care
- Diagnosis-Related Groups
- Evaluation Studies
- Family Practice
- Health Expenditures
- Hospitalization
- Humans
- Kazakhstan
- Physicians, Family
- Primary Health Care
- USSR
- United States
- economics
- hsrmtgs
Other ID:
UI: 102215653
From Meeting Abstracts