British Columbia's pay-for-performance experiment: part of the solution to reduce emergency department crowding?

Health Policy. 2013 Nov;113(1-2):86-92. doi: 10.1016/j.healthpol.2013.07.010.


Background: Emergency department (ED) overcrowding continues to be a well-publicized problem in a number of countries. In British Columbia, a province in Canada, an ED pay-for-performance (ED P4P) program was initiated in 2007 to create financial incentives for hospitals to reduce patients' ED length of stay (ED LOS). This study's objectives are to determine if the ED P4P program is associated with decreases in ED LOS, and to address the ED P4P program's limitations.

Methods: We analyze monthly hospital-level ED LOS time data since the inception of the financial incentives. Since the ED P4P program was phased in at different hospitals from different health authorities over time, hospitals' data from only two regional health authorities are included in the study.

Results: We find association between the implementation of ED P4P and ED LOS time data. However, due to the lack of control data, the findings cannot demonstrate causality. Furthermore, our findings are from hospitals in the greater Vancouver area only.

Interpretation: BC's ED P4P was introduced to create incentives for hospitals to reduce ED LOS by providing incremental incentive funding. Available data indicate that the ED P4P program is associated with mixed successes in reducing ED LOS among participating hospitals.

Keywords: Emergency department length of stay; Emergency department overcrowding; Emergency department wait time; Hospital funding policy.

MeSH terms

  • British Columbia
  • Crowding*
  • Efficiency, Organizational
  • Emergency Service, Hospital / economics
  • Emergency Service, Hospital / statistics & numerical data*
  • Humans
  • Length of Stay / economics
  • Length of Stay / statistics & numerical data*
  • Reimbursement, Incentive*