Elsevier

Health Policy

Volume 113, Issues 1–2, November 2013, Pages 86-92
Health Policy

British Columbia's pay-for-performance experiment: Part of the solution to reduce emergency department crowding?

https://doi.org/10.1016/j.healthpol.2013.07.010Get rights and content
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Abstract

Background

Emergency department (ED) overcrowding continues to be a well-publicized problem in a number of countries. In British Columbia, a province in Canada, an ED pay-for-performance (ED P4P) program was initiated in 2007 to create financial incentives for hospitals to reduce patients’ ED length of stay (ED LOS). This study's objectives are to determine if the ED P4P program is associated with decreases in ED LOS, and to address the ED P4P program's limitations.

Methods

We analyze monthly hospital-level ED LOS time data since the inception of the financial incentives. Since the ED P4P program was phased in at different hospitals from different health authorities over time, hospitals’ data from only two regional health authorities are included in the study.

Results

We find association between the implementation of ED P4P and ED LOS time data. However, due to the lack of control data, the findings cannot demonstrate causality. Furthermore, our findings are from hospitals in the greater Vancouver area only.

Interpretation

BC's ED P4P was introduced to create incentives for hospitals to reduce ED LOS by providing incremental incentive funding. Available data indicate that the ED P4P program is associated with mixed successes in reducing ED LOS among participating hospitals.

Keywords

Emergency department overcrowding
Hospital funding policy
Emergency department wait time
Emergency department length of stay

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