The Impact of Pay-for-Performance in BC Emergency Departments on health Outcomes and Use

Project number: 
Approval date: 
Wednesday, July 17, 2013
Principal Investigator: 
University of British Columbia (UBC)
Funding Agency: 
not grant funded
Datasets requested: 
Not available
Research objective: 

This study will examine the impact of PFF in BC emergency departments on patient health outcomes and the use of medical care outside of the emergency department. A range of patient health and treatment outcomes will be examined, which goes beyond the previous studies that simply focus on average wait and discharge times in EDs. There are two main research questions this study will address, which are outlined below, along with the research hypotheses.

Research Question 1: What is the impact of PFF on patient health outcomes and subsequent care in the short and long run?

This is an important question to answer because there are many paths to lower wait times in EDs including some that shift waits for treatment (e.g. by shifting patients to other providers for treatment) or that lower treatment quality. One hypothesis is that physicians may respond to the new funding structure by shifting costs of treatment from the ED to other medical care providers such as physician clinics or outpatient care centres (including other hospital departments). This may be observed either as an increase in referrals from ED physicians or as an increase in subsequent outpatient medical visits by patients. This research examines whether the health outcomes of patients, as well as the frequency of their subsequent medical care visits, are affected by the new funding structure in emergency departments.

Research Question 2: What is the impact of PFF on an individual hospital's ED use by patients?

A secondary goal of PFF is to create competition between healthcare providers in publicly funded systems, whereby funding follows the patient. This research project will test whether PFF changed the volume of patients seen at each hospital. One hypothesis we will examine is whether PFF hospitals attracted individuals from the non-PFF hospitals due to lower average wait times. If hospitals that are marginally further away from an individual's home begin to reduce their wait times, then this could induce individuals to switch where they seek medical treatment, possibly going further for treatment or seeking care outside their local health area. Related to this, we will examine the impact of lower average ED wait times on where patients obtain care. One hypothesis is that some patients who would have otherwise seen a general practitioner (GP) might now be presenting themselves at EDs for certain illnesses given average wait times are lower. As such, this study will examine if PFF increased the volume of patients at EDs, substituting away from GP visits. It is consequently important to examine patients who not only visit EDs, but also those individuals who seek care at other providers for which ED care may be a close substitute. This is most relevant in situations where medical care is sought for non-urgent illnesses.

Understanding the manner in which the change in hospital funding affected outcomes beyond average wait times and discharges is a key component to a proper evaluation of PFF in BC hospitals. By addressing the two main questions above, this research study allows a better understanding of the impact of pay-for-performance schemes. Its findings can consequently be used to inform health policy.

Page last revised: December 5, 2017