Project description

The Ministry of Public Health (MoPH) contracts with 135 public and private hospitals to provide hospitalization services to 52% of Lebanon's citizens. Since 2001 the MoPH has used a three-tier reimbursement rate for hospitals based on their results in a hospital accreditation process. Evidence has accumulated over the past several years that this contracting mechanism was not appropriate, and the MoPH has turned to performance-based contracting (PBC) to address its lack of information on services provided (classical principal-agent problem).

The research team will develop a PBC intervention between the MoPH and hospitals, and evaluate its impact at patient and health system/hospital levels. Our principle research question is: What factors determine the impact of performance-based hospital contracting to improve patient outcomes, equity and efficiency?

We will use a mixed-methods approach, with qualitative and quantitative components. The MoPH hospitalization database will be used to measure hospital case-mix, service utilization and cost, and 30-day readmissions for specific conditions/procedures. We will design a patient satisfaction questionnaire using focus group discussions, and apply it to measure patient satisfaction across hospitals. With one year of pre-intervention data available the baseline hospital performance will be calculated and used by the MoPH to set new hospital reimbursement rates. With one year of post-intervention data available we will evaluate PBC impact at patient and health system/hospital levels. We will also interview a sample of hospital managers to investigate changes hospitals undertook as a response to PBC (e.g. staff incentives, trainings).

We will share our findings using stakeholder seminars, policy roundtables, professional networks, policy briefs and other knowledge-translation tools, and use this to use our findings to inform future development of PBC in Lebanon and similar initiatives in low/middle-income countries.

Researchers

Keywords

Medical sociology Public health Health policy