title: Effects of payment mechanisms on hospital behaviours in Brazil: evidence from a multi-payer and multi-payment system.
abstract: A variety of provider payment mechanisms (PPMs) are used in Brazil to direct funds to hospitals. This article examines their effect on hospital efficiency, cost and quality. Public hospitals funded through the traditional line-item public budget are the best least efficient. Those funded through global budgets and other decentralized budget modalities perform on a par with private providers funded mainly by private prepaid health plans. Private hospitals that are dependent on government payments exhibit lower levels of quality. However, the overall effects of PPMs on performance are less than expected for some groups of hospitals. Factors compromising the impact of PPMs on performance are examined.
authors.affiliation: Performa Institute, Brazil.
authors.forename: Bernard F
authors.initials: BF
authors.lastname: Couttolenc
authors.forename: Gerard M
authors.initials: GM
authors.lastname: Forgia
mesh_terms: D001938:Brazil; D004469:Economics, Hospital / Q000458:organization & administration*; D012051:Reimbursement Mechanisms / Q000458:organization & administration*