Financial penalty associated with a decline in hospital-acquired complications in Australia
Year: 2025
Type: article
Study design: Observational Study
Abstract: • Evidence for pay-for-performance (p4p) and hospital patient safety has been inconclusive. • A p4p policy targeting hospital-acquired complications was introduced across Australia. • The policy’s introduction was associated with a decline in complications. • No evidence of gaming and systematic miscoding was observed. • P4p may can potentially complement other efforts to improve safety of hospital care. Adverse events during hospital care are a global concern. The evidence for addressing unsafe acute care using pay-for-performance (p4p) is inconclusive. To examine association between the introduction of a financial penalty on 1 July 2018 and the prevalence of 13 high-priority hospital-acquired complications (HACs) in Australian public hospitals. Administrative data on every Australian public hospital separation (age >17 years) between 1 January 2014 and 30 June 2021 was used to analyse changes in quarterly HAC prevalence (per 1000 multi-day separations), standardized to the study population, using two interrupted time series methods: generalized least squares (GLS) with autoregressive moving average (ARMA) errors, and a Bayesian structured time series. Just under 20 million separations took place over the study period with 947,057 (4.7%) (mean age 69 (SD: 18), 48% female) recording at least one HAC and 1,263,646 HACs overall. Our GLS model estimated a decline of 17% (95% CI 12 – 22%) in HAC prevalence associated with the introduction of the penalty. The Bayesian model estimated a 26% (23 – 29%) decline. Most of the decline occurred during a 12-month roll-in period. Results suggest that 98,970 fewer inpatients experienced a HAC from 1 July 2018 to 30 June 2021 compared to the modelled counterfactual. Implementation of a financial penalty was associated with a substantial decline in HACs. Few other p4p policies have been associated with reductions in inpatient harm. Future research should examine local HAC trends and investigate what other factors may have contributed to the change.
Source: Health Policy
Language: English
Subfield: Health Information Management
Field: Health Professions
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,220
OpenAlex ID: W4413214741