Limited Consequences of a Transition From Activity-Based Financing to Budgeting: Four Reasons Why According to Swedish Hospital Managers
Activity-based financing (ABF) and global budgeting are two common reimbursement models in hospital care that embody different incentives for cost containment and quality. The purpose of this study was to explore and describe perceptions from the provider perspective about how and why replacing vari...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2019-04-01
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| Series: | Inquiry: The Journal of Health Care Organization, Provision, and Financing |
| Online Access: | https://doi.org/10.1177/0046958019838367 |
| _version_ | 1819032841885843456 |
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| author | Lina Maria Ellegård PhD Anna Häger Glenngård PhD |
| author_facet | Lina Maria Ellegård PhD Anna Häger Glenngård PhD |
| author_sort | Lina Maria Ellegård PhD |
| collection | DOAJ |
| description | Activity-based financing (ABF) and global budgeting are two common reimbursement models in hospital care that embody different incentives for cost containment and quality. The purpose of this study was to explore and describe perceptions from the provider perspective about how and why replacing variable ABF by global budgets affects daily operations and provided services. The study setting is a large Swedish county council that went from traditional budgeting to an ABF system and then back again in the period 2005-2012. Based on semistructured interviews with midlevel managers and analysis of administrative data, we conclude that the transition back from ABF to budgeting has had limited consequences and suggest 4 reasons why: (1) Midlevel managers dampen effects of changes in the external control; (2) the actual design of the different reimbursement models differed from the textbook design; (3) the purchasing body’s use of other management controls did not change; (4) incentives bypassing the purchasing body’s controls dampened the consequences. The study highlights the challenges associated with improvement strategies that rely exclusively on budget system changes within traditional tax-funded and politically managed health care systems. |
| first_indexed | 2024-12-21T07:08:21Z |
| format | Article |
| id | doaj.art-eb04108e5157456bb976e5c08d562470 |
| institution | Directory Open Access Journal |
| issn | 0046-9580 1945-7243 |
| language | English |
| last_indexed | 2024-12-21T07:08:21Z |
| publishDate | 2019-04-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Inquiry: The Journal of Health Care Organization, Provision, and Financing |
| spelling | doaj.art-eb04108e5157456bb976e5c08d5624702022-12-21T19:12:02ZengSAGE PublishingInquiry: The Journal of Health Care Organization, Provision, and Financing0046-95801945-72432019-04-015610.1177/0046958019838367Limited Consequences of a Transition From Activity-Based Financing to Budgeting: Four Reasons Why According to Swedish Hospital ManagersLina Maria Ellegård PhD0Anna Häger Glenngård PhD1Lund University, SwedenLund University, SwedenActivity-based financing (ABF) and global budgeting are two common reimbursement models in hospital care that embody different incentives for cost containment and quality. The purpose of this study was to explore and describe perceptions from the provider perspective about how and why replacing variable ABF by global budgets affects daily operations and provided services. The study setting is a large Swedish county council that went from traditional budgeting to an ABF system and then back again in the period 2005-2012. Based on semistructured interviews with midlevel managers and analysis of administrative data, we conclude that the transition back from ABF to budgeting has had limited consequences and suggest 4 reasons why: (1) Midlevel managers dampen effects of changes in the external control; (2) the actual design of the different reimbursement models differed from the textbook design; (3) the purchasing body’s use of other management controls did not change; (4) incentives bypassing the purchasing body’s controls dampened the consequences. The study highlights the challenges associated with improvement strategies that rely exclusively on budget system changes within traditional tax-funded and politically managed health care systems.https://doi.org/10.1177/0046958019838367 |
| spellingShingle | Lina Maria Ellegård PhD Anna Häger Glenngård PhD Limited Consequences of a Transition From Activity-Based Financing to Budgeting: Four Reasons Why According to Swedish Hospital Managers Inquiry: The Journal of Health Care Organization, Provision, and Financing |
| title | Limited Consequences of a Transition From Activity-Based Financing to Budgeting: Four Reasons Why According to Swedish Hospital Managers |
| title_full | Limited Consequences of a Transition From Activity-Based Financing to Budgeting: Four Reasons Why According to Swedish Hospital Managers |
| title_fullStr | Limited Consequences of a Transition From Activity-Based Financing to Budgeting: Four Reasons Why According to Swedish Hospital Managers |
| title_full_unstemmed | Limited Consequences of a Transition From Activity-Based Financing to Budgeting: Four Reasons Why According to Swedish Hospital Managers |
| title_short | Limited Consequences of a Transition From Activity-Based Financing to Budgeting: Four Reasons Why According to Swedish Hospital Managers |
| title_sort | limited consequences of a transition from activity based financing to budgeting four reasons why according to swedish hospital managers |
| url | https://doi.org/10.1177/0046958019838367 |
| work_keys_str_mv | AT linamariaellegardphd limitedconsequencesofatransitionfromactivitybasedfinancingtobudgetingfourreasonswhyaccordingtoswedishhospitalmanagers AT annahagerglenngardphd limitedconsequencesofatransitionfromactivitybasedfinancingtobudgetingfourreasonswhyaccordingtoswedishhospitalmanagers |