Pricing hospital care: Global budgets and marginal pricing strategies

Health Policy. 2015 Aug;119(8):1111-8. doi: 10.1016/j.healthpol.2015.04.011. Epub 2015 Apr 25.


Objective: The Canadian province of British Columbia (BC) is adding financial incentives to increase the volume of surgeries provided by hospitals using a marginal pricing approach. The objective of this study is to calculate marginal costs of surgeries based on assumptions regarding hospitals' availability of labor and equipment.

Data: This study is based on observational clinical, administrative and financial data generated by hospitals. Hospital inpatient and outpatient discharge summaries from the province are linked with detailed activity-based costing information, stratified by assigned case mix categorizations.

Study design: To reflect a range of operating constraints governing hospitals' ability to increase their volume of surgeries, a number of scenarios are proposed. Under these scenarios, estimated marginal costs are calculated and compared to prices being offered as incentives to hospitals.

Principal findings: Existing data can be used to support alternative strategies for pricing hospital care. Prices for inpatient surgeries do not generate positive margins under a range of operating scenarios. Hip and knee surgeries generate surpluses for hospitals even under the most costly labor conditions and are expected to generate additional volume.

Conclusions: In health systems that wish to fine-tune financial incentives, setting prices that create incentives for additional volume should reflect knowledge of hospitals' underlying cost structures. Possible implications of mis-pricing include no response to the incentives or uneven increases in supply.

Keywords: Global budgets; Hospital payment; Hospital prices; Marginal cost; Marginal price.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Budgets*
  • Economics, Hospital* / organization & administration
  • Fees, Medical*
  • Hospital Costs*
  • Humans
  • Surgical Procedures, Operative / economics
  • Surgical Procedures, Operative / statistics & numerical data