Paying for efficiency: Incentivising same-day discharges in the English NHS

Research output: Book/ReportOther report



Publication details

DatePublished - Aug 2018
Number of pages35
PublisherCentre for Health Economics, University of York
Place of PublicationYork
Original languageEnglish

Publication series

NameCHE Research Paper
PublisherCentre for Health Economics, University of York


We study a pay-for-efficiency scheme that encourages hospitals to admit and discharge patients on the same calendar day where clinically appropriate. Since 2010, hospitals in the English NHS receive a higher price for patients treated as same-day discharge than for overnight stays, despite the former being less costly. We analyse administrative data for patients treated for 191 conditions for which same-day discharge is clinically appropriate — of which 32 are incentivised — during 2006-2014. Using interrupted time series, differences-in-differences and synthetic control methods, we find that the policy generally had
a positive effect on planned conditions with a statistically significant effect in about a third of conditions. The results are more mixed for emergency conditions. The median elasticity (across all 32 conditions) is 0.09 but above one for six conditions. Condition-specific design features explain some, but not all, of the differential responses.

Bibliographical note

© 2018 the author. The full text of this report can be viewed free of charge from the Centre for Health Economics web site at:

    Research areas

  • Pay for Performance, Best Practice Tariff, day surgery, same-day discharge, policy evaluation

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