  Pay-for-performance approaches have been widely adopted in order to drive
improvements in the quality of healthcare provision. Previous studies
evaluating the impact of these programs are either limited by the number of
health outcomes or of medical conditions considered. In this paper, we evaluate
the effectiveness of a pay-for-performance program on the basis of five health
outcomes and across a wide range of medical conditions. The context of the
study is the Lombardy region in Italy, where a rewarding program was introduced
in 2012. The policy evaluation is based on a difference-in-differences
approach. The model includes multiple dependent outcomes, that allow
quantifying the joint effect of the program, and random effects, that account
for the heterogeneity of the data at the ward and hospital level. Our results
show that the policy had a positive effect on the hospitals' performance in
terms of those outcomes that can be more influenced by a managerial activity,
namely the number of readmissions, transfers and returns to the surgery room.
No significant changes which can be related to the pay-for-performance
introduction are observed for the number of voluntary discharges and for
mortality. Finally, our study shows evidence that the medical wards have
reacted more strongly to the pay-for-performance program than the surgical
ones, whereas only limited evidence is found in support of a different policy
reaction across different types of hospital ownership.
