Costs and Quality at the Hospital Level in the Nordic Countries

Abstract

This article develops and analyzes patient register-based measures of quality for the major Nordic countries. Previous studies show that Finnish hospitals have significantly higher average productivity than hospitals in Sweden, Denmark, and Norway and also a substantial variation within each country. This paper examines whether quality differences can form part of the explanation and attempts to uncover quality-cost trade-offs.Data on costs and discharges in each diagnosis-related group for 160 acute hospitals in 2008-2009 were collected. Patient register-based measures of quality such as readmissions, mortality (in hospital or outside), and patient safety indices were developed and case-mix adjusted. Productivity is estimated using bootstrapped data envelopment analysis.Results indicate that case-mix adjustment is important, and there are significant differences in the case-mix adjusted performance measures as well as in productivity both at the national and hospital levels. For most quality indicators, the performance measures reveal room for improvement. There is a weak but statistical significant trade-off between productivity and inpatient readmissions within 30 days but a tendency that hospitals with high 30-day mortality also have higher costs. Hence, no clear cost-quality trade-off pattern was discovered. Patient registers can be used and developed to improve future quality and cost comparisons.

Productivity growth, case mix and optimal size of hospitals. A 16-year study of the Norwegian hospital sector

“…Some recent studies have incorporated quality indices as an output measure or otherwise controlled for quality [23]. In this paper we have measured only the hospital production by volume based on average costs, not the contents of that production.…”

“…The method has been used at different levels: comparing nations [20], regions [21] but more commonly hospitals. In Norway and the Nordic countries there are numerous examples of DEA used for estimating hospital productivity [9,11,17,[22][23][24][25][26][27]. The method is favoured in environments where substantial measurement errors are unlikely and with multiple inputs and/or outputs [7,28,29].…”

A Window on Geographic Variation in Health Care: Insights from EuroHOPE

“…1 It should be mentioned that the Italian data were not nationally representative and covered relatively wealthy Italian regions. In Kittelsen et al (2015), hospitals were the spatial units of analysis. The regions were bigger for VLBW and VLGA infants (e.g.…”

“…Five specific diseases (acute myocardial infarction (AMI), breast cancer, hip fracture, stroke and infants born with very low birth weight (VLBW) and/or very low gestational age (VLGA) (further referred to as VLBW/VLGA infants) were selected to serve as case studies and for which countrywide patient data were collected in the participating countries (Finland, Hungary, Italy, 1 the Netherlands, Norway, Scotland and Sweden) Hagen et al, 2015aHagen et al, , 2015bMalmivaara et al, 2015;Medin et al, 2015;Numerato et al, 2015;Peltola et al, 2015;Smith et al, 2015). In addition, one study was carried out with the hospital as unit of analysis and including all diseases treated in the hospital (Kittelsen et al, 2015). For this analysis, hospital patient data from the Nordic countries only were used.…”

The DRG-Based Hospital Prospective Payment System in Greece: An Assessment of the Reimbursement Rates Using Clinical Severity Classification

“…Australia was one of the first countries that followed the USA paradigm, and adapted its own specific AR-DRG classification based upon 23 major diagnostic categories (MDC) [16]. Nordic countries [17] (Norway, Sweden, Finland and Denmark) introduced the Nordic DRGs (Nord DRGs) based on a refined DRG from Health Care Financing Administration (HFA-DRGs) [18], Estonia [19], has introduced and gradually implemented (50% of case cost) the Nord DRGs since 2003. Iceland [14] has been using the Nord DRGs on a trial basis in Landspitali University Hospital since 2001.…”