Intended for healthcare professionals


Hospitals pay penalties of £1.2bn for “too many” admissions and “too early” discharges

BMJ 2014; 348 doi: (Published 19 February 2014) Cite this as: BMJ 2014;348:g1653
  1. Nigel Hawkes
  1. 1London

Schemes designed to penalise hospitals in England for exceeding agreed numbers of emergency admissions and for readmitting patients within four weeks of discharge have cost them more than £1.2bn over the past four years, an investigation by the Channel 4 programme Dispatches has found.

The penalty schemes aim to discourage hospitals from increasing numbers of emergency admissions beyond agreed levels and from discharging patients before they are well enough. For any unbudgeted emergency admissions, hospitals are paid at only 30% of the normal tariff, the so called “marginal tariff.” Funds are also withheld for readmissions within 30 days of an elective procedure and for some other readmissions, subject to local negotiation.

The marginal tariff rule was introduced because Payment by Results, the scheme that …

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