The effects of bonus payments on emergency service performance in Victoria

Med J Aust. 1999 Sep 6;171(5):243-6. doi: 10.5694/j.1326-5377.1999.tb123630.x.


Objectives: To review and analyse the system effects of the Emergency Service Enhancement Program (ESEP): bonus payments made to public hospitals to improve access to care for patients attending emergency departments.

Design: A review of the first 3 years' performance data, obtained from the Victorian Emergency Department Minimum Dataset (VEMD).

Setting: 21 public hospital emergency departments in Victoria, Australia (population 4.5 million), with about 700,000 patient attendances per year. The ESEP began in April 1995.

Main outcome measures: The ESEP indicators of emergency department and inpatient bed access: occasions of "ambulance bypass" (emergency department unable to accept patients arriving by ambulance); emergency waiting times for Category 1, 2 and 3 patients (National Triage Scale) compared with agreed national performance thresholds; and "access block" (> 12 hours' waiting time in the emergency department before admission to hospital).

Results: The number of occasions of ambulance bypass per quarter decreased from 600 in 1994 to fewer than 100 in 1997 (P < 0.001). Despite an increased proportion of patient encounters in triage categories 1, 2 and 3 (31% v. 23%), zero waiting times for Category 1 patients were consistently adhered to, and adherence to waiting time thresholds for Category 2 and 3 patients improved significantly (P < 0.001, R2 = 0.74; and P < 0.035, R2 = 0.37, respectively), particularly for Category 2 patients. The number of patients waiting longer than 12 hours in emergency departments decreased non-significantly (P = 0.3, R2 = 0.1).

Conclusion: Our results show that the ESEP has produced sustained improvements in all the indicators linked with bonus payments.

MeSH terms

  • Diagnosis-Related Groups / economics
  • Emergency Medical Services / economics
  • Emergency Medical Services / organization & administration
  • Emergency Medical Services / standards*
  • Emergency Medical Services / statistics & numerical data
  • Humans
  • Quality Assurance, Health Care*
  • Reimbursement, Incentive*
  • Time Factors
  • Triage / classification*
  • Victoria