Published 22 September 2009, doi:10.1136/bmj.b3858
Cite this as: BMJ 2009;339:b3858

Letters

Payment by results

Has payment by results affected how care is recorded?

The first 150 words of the full text of this article appear below.

Payment by results has changed the recorded inpatient activity of hospitals,1 but whether this represents a genuine change in activity or a change in the way activity is recorded is not clear. Take as an example upper gastrointestinal endoscopy—a common procedure performed on patients who are not otherwise staying in hospital.

Historically, some hospitals recorded these procedures as day case admissions, others as outpatient procedures. It did not matter: the patient got the test, and the hospital got paid under the block contract. Under payment by results, however, the hospital gets more income for a day case admission with procedure than for an outpatient procedure. Astute business managers will ensure that activity is recorded for administrative purposes in whichever legitimate manner will maximise income.

The side effects of such a change in recording include boosting many perceived positive indicators of good or efficient care. The number (and proportion) of day . . . [Full text of this article]

John P Watson, consultant physician1

1 St James’s University Hospital, Leeds LS9 7TF

john.watson@leedsth.nhs.uk


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Relevant Article

Has payment by results affected the way that English hospitals provide care? Difference-in-differences analysis
Shelley Farrar, Deokhee Yi, Matt Sutton, Martin Chalkley, Jon Sussex, and Anthony Scott
BMJ 2009 339: b3047. [Abstract] [Full Text] [PDF]

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