[Prospective payment per case and length of stay at coordinated private hospitals].
BACKGROUND
In 1991 the Valencian Health Service (SVS) introduced a system of prospective payment per process to reimburse some surgical interventions to coordinated private hospitals which, until then, had invoiced by retrospective payment per hospital stay. The impact of this change on the mean length of stay in seven groups of surgical interventions is evaluated.


METHODS
Retrospective analysis of the mean stay of 2025 admissions in private hospitals coordinated under both systems of payment (payment per process 66%, October 91 to February 92; payment by stay 64%, March 91 to February 92) for seven groups of surgical procedures: cataract surgery, cholecystectomy, hernioraphy, prostate resection, tonsillectomy-adenoidectomy, varicose vein and proctologic procedures was carried out.


RESULTS
Mean hospital stay decreased (mean = 5.4 days; p < 0.001) in all the groups reimbursed under PRP (from 72% in proctologic conditions to 43% for adenoidectomy-tonsillectomy) avoiding 8727 stays. The coinciding period under both systems demonstrated a decrease of mean hospital stay similar to the total period.


CONCLUSIONS
The coordinated hospitals demonstrated a surprisingly rapid capacity to modify their organizative behaviour or influence the styles of clinical practice or both to adopt the patterns of length of stay which optimize profits according to the system of payment used by the SVS.
Peiró Moreno
S
S
Instituto Valenciano de Estudios en Salud Pública.
Meneu de Guillerna
R
R
Roselló Pérez
M
M
Tobed Ferreiro
M
M
D016304:Hospitals, Private / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D011445:Prospective Payment System / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013030:Spain
Pago prospectivo por caso y duración de la estancia en hospitales privados concertados.