Impact of provider payment reforms on hospital productivity in Kazakhstan

Worldwide demand for enhanced hospital productivity has propelled the implementation of new provider payment schemes across many countries. The impact of these hospital payment reforms on hospital productivity is, however, rather under-researched. This thesis aims to address this evidence gap by conducting two case studies on provider payment reforms in Kazakhstan. It aims to provide a comprehensive understanding of intended and unintended consequences of hospital payment systems, review and address any limitations of their evaluation methods. A systematic literature review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and was conducted to a) explore the consequences of hospital payment reforms in the global context, b) critically assess the methods applied in studies on hospital payment reforms. Two quasi-experimental designs, a controlled interrupted series approach and a single interrupted time-series were used to evaluate the immediate and delayed impacts of the newly introduced provider payment policies: diagnosis-related groups and global budgets. The thesis employed administrative hospital data for the period of 2011-2013 provided by the Ministry of Health of the Republic of Kazakhstan. The controlled interrupted time-series was employed for three hospital levels separately (regional, city and district hospitals) to assess the impact of the patient-based payment system, whereas the matching technique was performed to find the closest pair of piloted and non-piloted hospitals to balance them on a set of baseline characteristics. The single interrupted time series was employed to assess the introduction of the global budget payment system in district hospitals. The studies suggest that the two hospital payment systems that were consequently introduced in Kazakhstan had a limited effect on hospital productivity. The amount of healthcare services is likely to increase as a result of the change of payment system from fee-for-services to diagnosis-related groups. On the other hand, a switch from diagnosis-related Groups to global budgets is likely to bring some reverse effects where the amount as well as complexity of healthcare provision are decreased.