Case mix measures and diagnosis‐related groups: opportunities and threats for inpatient dermatology

Hensen, Peter; Fürstenberg, Torsten; Luger, T A; Steinhoff, Martin; Roeder, N.

doi:10.1111/j.1468-3083.2005.01258.x

Cited by 22 publications

(27 citation statements)

References 20 publications

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“…In the first step, products (e.g., items, cases) have to be defined so that, in the second step, prices for these products can be determined or negotiated [3]. Products can either be defined as individual medical procedures performed (e.g., the DBC system in the Netherlands with its 29,000 items), as groups of medical procedures (e.g., the procedure-oriented system in Poland with its 1,400 items), or as a combination of clinical, demographic, and resource consumption data (i.e., as is usually applied in DRG-related patient classification systems) [23]. The second step involves calculating, setting, or negotiating per-product prices.…”

Section: Defining Pricesmentioning

confidence: 99%

Methods to determine reimbursement rates for diagnosis related groups (DRG): A comparison of nine European countries

Schreyögg

Stargardt

Tiemann

et al. 2006

Health Care Manage Sci

171

121

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Over the past 20 years, most European countries have introduced DRGs or similar grouping systems as instruments for hospital reimbursement. This paper compares and analyzes the methods used to determine prices for inpatient care within DRGs or similar grouping systems employed in nine EU member states (i.e., Denmark, France, Germany, Hungary, Italy, Tthe Netherlands, Poland, Spain and England). It categorizes the systems of patient classification used in these nine countries and compares them according to the three steps necessary in order to set prices: 1.) definition of a data sample, 2.) use of trimming methods and plausibility checks and 3.) definition of prices. It concludes with a discussion on the typical development path of DRG systems and the role of additional reimbursement components in this context.

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Section: Defining Pricesmentioning

confidence: 99%

Methods to determine reimbursement rates for diagnosis related groups (DRG): A comparison of nine European countries

Schreyögg

Stargardt

Tiemann

et al. 2006

Health Care Manage Sci

171

121

View full text Add to dashboard Cite

show abstract

“…This so-called compression was also found in other countries after they introduced DRG-systems [19][20][21]. The phenomenon may be exacerbated by the fact that the data collection in the data-sharing programme is not timely, since the G-DRG system 2006 reflects 2004's treatment patterns [22]. the former payment system based on payment per day, which was characterised by a very LOS-oriented approach to treatment in German hospitals [8].…”

Section: Calculating Deductions For Short-stay Outliers and Surchargementioning

confidence: 94%

Cost accounting to determine prices: How well do prices reflect costs in the German DRG-system?

Schreyögg

Tiemann

Busse

2006

Health Care Manage Sci

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Germany has recently introduced a system of Diagnosis Related Groups (DRGs) to engender more appropriate resource allocation. The following article describes the German DRG-system and the methodologies used to determine prices. It analyses the extent to which prices, or calculated cost weights, reflect the actual costs incurred by hospitals for their respective services. We reveal that a "compression" of DRG cost weights occurs, and that the data sample used to calculate cost weights is lacking in terms of its representativeness. Although cost data accuracy has improved over the last few years there are still a number of challenges that need to be addressed.

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“…[26] Some investigators believed that the early intervention in the DRG introduction process was partially successful because of improvement of the calculation standards, advancements in hospitals' cost accounting, and evaluation studies and recommendations concerning the DRG assignment. [27] DRGs could be used as a tool to facilitate more effective resource planning and cost management in hospitals. The methods used in this study could also be applied to other major diseases.…”

Section: Discussionmentioning

confidence: 99%

Developing case-mix standards with the Diagnosis-related Groups for payment reforms and hospital management in China: A case study in Xiamen city

Zeng

Lin

et al. 2016

IJH

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Objective: To inform health insurance payment reforms and hospital cost management by investigating the case-mix of viral hepatitis, a common disease, in a Chinese city. Methods: All inpatient medical records of viral hepatitis of selected hospitals in Xiamen from 2008 to 2013 were collected. Both univariate and multivariate analyses were performed to test the association between hospitalization costs and other key variables. The CHAID model was employed to generate the Diagnosis-related Groups (DRGS). Evaluation indexes were adopted to evaluate the grouped results. Standard expenditures were estimated for each group. Results: Gender, age, marital status, mode of payment, admission condition, discharged condition and length of stay were found significantly associated with inpatient expenditures, with p values smaller than .001. Eleven diagnosis-related groups were obtained with the CHAID methods and three classification nodes were obtained from the CHAID decision tree, including age, admission status and mode of payment. The analysis revealed a considerable discrepancy in expenditures across groups with similar characteristics. This variance suggests the existence of inflated inpatient costs as well as inefficient use of medical resources. Conclusions: The analysis provided more accurate estimation on case-mix costs for a major disease in China. The standard expenditures are of reference values for the social insurance administration in calibrating reimbursement rates in its move to case-mix payment system and helpful for hospital cost management.

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Case mix measures and diagnosis‐related groups: opportunities and threats for inpatient dermatology

Cited by 22 publications

References 20 publications

Methods to determine reimbursement rates for diagnosis related groups (DRG): A comparison of nine European countries

Methods to determine reimbursement rates for diagnosis related groups (DRG): A comparison of nine European countries

Cost accounting to determine prices: How well do prices reflect costs in the German DRG-system?

Developing case-mix standards with the Diagnosis-related Groups for payment reforms and hospital management in China: A case study in Xiamen city

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