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Payments By Results (P.B.R)

About PBR l  PBR Maternity

About PBR
PBR is the price set by the Department of Health that is payable for a specific procedure.  According to the Department of Health:

“The aim of Payment by Results (PbR) is to provide a transparent, rules-based system for paying trusts. It will reward efficiency, support patient choice and diversity and encourage activity for sustainable waiting time reductions. Payment will be linked to activity and adjusted for casemix. Importantly, this system will ensure a fair and consistent basis for hospital funding rather than being reliant principally on historic budgets and the negotiating skills of individual managers.”

(Department of Health website, 2007)

Click here to view a diagram showing the structure of PBR

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PBR in Maternity
Hospital maternity care is covered by PBR. However, community tariffs are not due to be set until 2009/10.  The delay has been the lack of reference costs and so it has not been possible to establish an adequate PBR tariff.   There is usually limited data recording the work of midwives or their activity levels, particularly those operating in the community. Therefore, a Finance Director of a trust may have a completely different financial view of maternity services from a Head of Midwifery.

This shows the importance of developing sustainable community services that are accurately costed. These locally agreed costs can then be given to the Department of Health and used as ‘reference costs’ to set the PBR tariff.  Without accurate prices being paid it is not possible to ensure a service is financially sustainable and so its future can never be guaranteed.  Maternal Link will provide facilities to collect and analyse data quickly and accurately for both financial and statistical benefit. 

Commissioners are becoming increasingly aware of the financial problems in maternity due to the miss-allocation of PBR codes, the best example of which is the use of N12.  This code is used when a woman is admitted antenatally for an event not related to delivery. This is usually a brief check-up (in a hospital setting midwives have said this is usually a 30 minute stint being monitored on the antenatal ward). The (non-elective) PBR tariff (N12) is £461. The tariff for a normal antenatal appointment is £40. 

Community care is more cost effective than acute care due to the reduction in unnecessary intervention and use of doctors staffing underutilised high-risk services. However, these savings will only be realised if all maternity care is accurately costed.


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