Investigation of the impact of DRG based reimbursement mechanisms on quality of care, capacity utilization, and efficiency- A systematic review

Barouni, Mohsen; Ahmadian, Leila; Anari, Hossein Saberi; Mohsenbeigi, Elham

doi:10.1080/20479700.2020.1782663

Cited by 8 publications

(10 citation statements)

References 40 publications

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“…Our findings are in line with previous research suggesting that DRG-like payment reform has limited and inconsistent effects on hospital activity; results vary depending on context and country [ 6 ]. For example, a systematic review found no clear trend in volume of care, and no consistent or systematic differences in mortality rates and quality of care, with considerable differences across countries and clinical domains [ 9 ].…”

Section: Discussionsupporting

confidence: 92%

“…Introduction of DRG-like payments led to improved technical efficiency, i.e., hospitals reduced cost per case without harming quality of care or increasing productivity in Portugal [ 45 ], Finland [ 46 ] and Norway [ 36 ] while in Austria, technical efficiency did not improve [ 47 ]. Systematic reviews report mixed effects of DRGs on hospital activity [ 6 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Evidence on the effects of DRGs on healthcare providers’ behavior as measured by LoS and volume of patients has been mixed, with different results in different countries [ 6 – 10 ]. In certain countries DRGs led to reduced LoS or increased volume of patients while in others the impact on LoS was not significant, suggesting that the effects differ as a function of context.…”

Section: Introductionmentioning

confidence: 99%

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It probably worked: a Bayesian approach to evaluating the introduction of activity-based hospital payment in Israel

Waitzberg

Siegel

Quentin

et al. 2022

Isr J Health Policy Res

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Background In 2013–2014, Israel accelerated adoption of activity-based payments to hospitals. While the effects of such payments on patient length of stay (LoS) have been examined in several countries, there have been few analyses of incentive effects in the Israeli context of capped reimbursements and stretched resources. Methods We examined administrative data from the Israel Ministry of Health for 14 procedures from 2005 to 2016 in all not-for-profit hospitals (97% of the acute care beds). Survival analyses using a Weibull distribution allowed us to examine the non-negative and right-skewed data. We opted for a Bayesian approach to estimate relative change in LoS. Results LoS declined in 7 of 14 procedures analyzed, notably, in 6 out of 7 urological procedures. In these procedures, reduction in LoS ranged between 11% and 20%. The estimation results for the control variables are mixed and do not indicate a clear pattern of association with LoS. Conclusions The decrease in LoS freed resources to treat other patients, which may have resulted in reduced waiting times. It may have been more feasible to reduce LoS for urological procedures since these had relatively long LoS. Policymakers should pay attention to the effects of decreases in LoS on quality of care. Stretched hospital resources, capped reimbursements, retrospective subsidies and underpriced procedures may have limited hospitals' ability to reduce LoS for other procedures where no decrease occurred (e.g., general surgery).

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

It probably worked: a Bayesian approach to evaluating the introduction of activity-based hospital payment in Israel

Waitzberg

Siegel

Quentin

et al. 2022

Isr J Health Policy Res

View full text Add to dashboard Cite

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“…Notably, after the implementation of the DIP payment reform for local patients, the other-insured-region patients still retain the FFS payment method, and hospitals may transfer the costs of the payment method reform to the other-insured-region patients. [13,37,38] In China, for some high-level hospitals, the scale of the otherinsured-region patients has exceeded that of local patients, and the source of income of the hospital's medical insurance fund has gradually changed from local to nationwide, which makes the medical insurance payment reform for the other-insured-region patients an urgent issue.…”

Section: The Difference In Changes In the Average Inpatient Costs Bet...mentioning

confidence: 99%

Do the effects of the DIP payment reform work for patients in the same city who are not yet covered by the reform? Evidence from Guangzhou, China

Wang

Huang

et al. 2023

Preprint

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Background The Reform of medical insurance payment methods is one of the crucial measures for controlling irrational medical practices. In China, the National Health Insurance Administration requires a full switch from the existing fee-for-service payment to DRG or DIP payments by 2025. Guangzhou, a city with a more developed economy and abundant medical resources in China, has completed the DIP payment reform for local-insured patients since 2018. However, patients from other-insured-region have not yet been included in the reform and still retain fee-for-service payment. This paper intends to prove that if DIP payment reform for local patients has made some effects and can these effects be simultaneously applied to the other-insured-region patients who are not covered by the payment reform. Methods The data in this paper were obtained from the database of basic medical insurance for urban employees of local and the other-insured-region patients in Guangzhou provided by the Guangzhou Healthcare Security Administration from 2017 to 2019. We used the average inpatient cost and the average rate of cost belonging to the medical insurance catalog to evaluate the changes in inpatient costs and reimbursement levels for both groups of patients before and after implementing the DIP payment reform. Single-group and multi-group interrupted time series were used to analyze the indicators. Results (1) After the DIP payment reform, local patients’ average inpatient costs fluctuated less between months compared with those before the policy implementation. (2) The average rate of cost belonging to the medical insurance catalog for local patients reflected a short- and long-term decreasing trend after the policy implementation, suggesting that patients’ burden increased and patients failed to enjoy the reform dividends. (3) The average inpatient costs of the other-insured-region patients were higher than those of local patients before and after the policy. The restraining effect on medical costs of the other-insured-region patients was not significant. (4) The average rate of cost belonging to the medical insurance catalog of the other-insured-region patients was lower than that of local patients, and after the implementation of the policy, although this indicator showed a significant downward trend in the long-term trend, but for some diseases was equal to or even higher than that of local patients. Conclusions On one hand, DIP payment reform for local patients has achieved some success, but still need further strengthening of regulation. On the other hand, the reform’s effect has not been synchronized with the effect on the other-insuerd-region patients. There is a risk that hospitals will pass on the payment reform cost to the other-insuerd-region patients.

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“…Una revisión sistemática de la literatura de los DRG recientemente publicada encontró que un resultado positivo de la implementación de sistemas de pago o reembolso basados en DRG es la reducción de la estancia promedio en los hospitales, aunque no todos los hospitales reportaron una reducción en los gastos hospitalarios después de su implementación. Otros resultados encontrados por esta revisión son: ninguno de los estudios mostró incremento en la mortalidad, solo el 25% de los estudios incluidos reportó incremento en la tasa de readmisiones, la mayor parte de los estudios mostró que este método transfirió costos a otros centros de salud y, finalmente, más de la mitad de los estudios encontraron que tras la implementación se redujeron el número de cirugías, tasas de hospitalización y exámenes de laboratorio (12).…”

Section: Intervenciones Sanitariasunclassified

Eficiencia en organizaciones prestadoras de servicios de salud: ilustración de casos en el contexto colombiano

Prada

2022

Rev. salud pública

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Los sistemas de salud comparten una preocupación mundial: la sostenibilidad financiera. El costo de oportunidad de los recursos públicos en escenarios de escasez demanda de académicos, hacedores de políticas y administradores en salud para buscar ineficiencias y corregirlas. Este artículo presenta un resumen de literatura de marcos conceptuales para entender e identificar ineficiencias en los sistemas de salud. También resume algunos hallazgos para Colombia, publicados en la literatura gris, e ilustra ejemplos de detección y corrección de ineficiencias en el ámbito de la prestación de servicios de salud en el país. En la mayoría de los casos ilustrados no se requieren cuantiosas inversiones; en su lugar, se requiere voluntad y liderazgo para la integración y coordinación de equipos de trabajo y el seguimiento de guías y protocolos de práctica clínica; apoyo institucional a procesos innovadores y compromiso institucional e investigación en mejores prácticas. Se resalta la necesidad de un cambio de cultura en las organizaciones prestadoras de servicios de salud hacia la medición con información para la toma de decisiones basada en evidencia.

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Investigation of the impact of DRG based reimbursement mechanisms on quality of care, capacity utilization, and efficiency- A systematic review

Cited by 8 publications

References 40 publications

It probably worked: a Bayesian approach to evaluating the introduction of activity-based hospital payment in Israel

It probably worked: a Bayesian approach to evaluating the introduction of activity-based hospital payment in Israel

Do the effects of the DIP payment reform work for patients in the same city who are not yet covered by the reform? Evidence from Guangzhou, China

Eficiencia en organizaciones prestadoras de servicios de salud: ilustración de casos en el contexto colombiano

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