Diagnosis related groups in Europe: moving towards transparency, efficiency, and quality in hospitals?

Abstract

. Diagnosis related groups in Europe: moving towards transparency, efficiency, and quality in hospitals?. BMJ (Clinical research ed.), 347 (7916), 1-7.

Paying for hospital care: the experience with implementing activity-based funding in five European countries

“…Compared with retrospective fee-for-service systems, improved efficiency (through minimising costs and input use) would also be encouraged (Aas, 1995;Newhouse, 1996;Ellis, 1998;Kutzin, 2001;Jegers et al, 2002;Langenbrunner and Wiley, 2002;Langenbrunner et al, 2005;Busse et al, 2011). Left unchecked, though, pure activity-based funding could lead to unintended adverse consequences, such as patient selection, inappropriate treatment and quality skimping (Aas, 1995;Ellis, 1998;Jegers et al, 2002).…”

Are cost differences between specialist and general hospitals compensated by the prospective payment system?

“…In contrast, other PPSs do consider organisational characteristics. In the French PPS, for instance, prices differ for public and private hospitals [3]. In some countries, the PPS provides greater compensation to allow for the costs of specialist care.…”

“…2 The NTPS is characterised by two key elements: the healthcare resource groups (HRGs), which classify patients into homogeneous categories based on diagnoses, procedures and some patients characteristics [3]; and the tariffs, which vary by HRG and admission type (elective or non-elective) and reflect the national cost for an HRG averaged across all hospitals [20]. An additional payment for excess bed days is made for patients whose length of stay is beyond a threshold, called the trim point, which also varies by HRG and admission type.…”

“…An additional payment for excess bed days is made for patients whose length of stay is beyond a threshold, called the trim point, which also varies by HRG and admission type. 3 Both the base and excess bed day tariffs are adjusted by the market forces factor (MFF) index to account for exogenous geographical differences in input prices [21]. Tariffs are inflated if the patient receives specialised services under specific HRGs [5].…”

Medical professionals’ responses to a DRG performance management system for hospital care in the Netherlands. Reinterpreting ‘perverse effects’, such as upcoding and patient selection, using arguments of professionalism and managerialism

“…The essence of DRG-based systems is the classification of patients into clinically and cost homogeneous groups that allows care providers to be remunerated on a standardized per-case basis (Sutherland and Botz 2006). DRGbased systems have been introduced in many EU countries, including the UK, Ireland, France, Germany, Austria, Sweden, Finland, Estonia, Poland, Portugal, Spain, and the Netherlands (Busse et al 2013). …”