Are English treatment centres treating less complex patients?

Area of Science:

• Health economics
• Healthcare policy
• Health services research

Background:

• Activity-based funding (ABF) reimburses healthcare providers based on patient payment categories.
• Patient complexity variations can lead to systematic differences in provider reimbursement.
• The introduction of specialized treatment centers in the English National Health Service (NHS) may exacerbate these differences.

Purpose of the Study:

• To assess patient complexity differences between hospitals and NHS treatment centers within 29 Healthcare Resource Groups (HRGs).
• To determine if patient selection or systematic differences in complexity exist between provider types under ABF.

Main Methods:

• Analysis of de-identified data for over 3.3 million patients in the English NHS.
• Comparison of patient characteristics (deprivation, diagnoses, procedures) between hospital-treated and treatment center-treated patients across HRGs.

Main Results:

• Patients treated in hospitals were more likely to originate from deprived areas compared to those in treatment centers.
• Hospital patients had a higher number of diagnoses and underwent significantly more procedures than treatment center patients.
• These findings suggest hospitals manage more complex patient cases than specialized treatment centers.

Conclusions:

• Significant differences in patient complexity exist between hospitals and treatment centers under the current HRG system.
• These complexity variations may impact cost and reimbursement fairness.
• Refinement of payment categories is recommended to ensure equitable reimbursement for providers treating more complex cases.