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

Abstract

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.

Health service costs in Europe: cost and reimbursement of primary hip replacement in nine countries

“…DRG systems attempt to classify cases according to medical criteria (main diagnosis) and economic severity (costs), allowing for a certain amount of cost variation within a DRG (Schreyo¨gg et al, 2006). As the definition for this case of total hip replacement excludes any comorbidity, it can be assumed that the selected cases are less severe and therefore less costly than the average case within the respective DRG.…”

The burden of hospitalizations for anus and penis neoplasm in Spain (1997–2008)

“…Each group has similar weight in hospital costs and can be applied to each related patient. DRGs calculations are made by 3M with Core Grouping System Software 38 …”

Burden of adult varicella hospitalizations in Spain (2001-2007)

“…DRGs calculations were made by 3M with Core Grouping System Software. 29 Statistical methods. The unit of analysis was the hospital discharge.…”