Performance regulation in a networked healthcare system: From cosmetic to institutionalized compliance

Abstract

Funding information

The role(s) of accounting and performance measurement systems in contemporary public administration

“…The following articles in this special issue adopt case study approaches to explore the role of different drivers of the institutionalization of performance measurement systems, the dynamics of such systems, as well as their effects and consequences. Along these lines, the articles by Carter et al (2019) and van Erp et al (2019) both look at change processes. The former explores the roles of accounting alongside organizational leadership and strategy in influencing change.…”

“…Van Erp et al (2019) explore the role of responsive regulations (i.e., non-coercive, educative interventions; informal, professional social control; reputational pressure; and sanctions as last resort) in ensuring compliance with a performance measurement regime (i.e., DRG) which is used for resource allocation in a setting that is characterized by multiple networked actors and logics. Using a mixed-method approach, combining almost 60 interviews with network actors and a survey of over 600 medical specialists, the results show that a non-coercive, persuasive and mainly dialogue-oriented regulatory strategy to engage with the emerging accountability structures in the network (i.e., new actors and mechanisms) stimulated attitudinal and behavioural changes.…”

Opening the black box of diagnosis-related groups (DRGs): unpacking the technical remuneration structure of the Dutch DRG system

“…Although this reduction has arguably decreased the possibilities for upcoding (many previous separate codes are now clustered), it also leads to a growing distance between care and coding practices, thus necessitating regular updates. In fact, the NZa facilitates this by having close contacts with professional and hospital associations in which the design of the system is discussed (van Erp et al, 2018).…”

“…In addition, health insurers control the billings sent in by the hospitals. Hence, the introduction of the DTC/DOT system, and with that the grouper, not so much changed the nature of hospital billing but changed the system of billing and reimbursement, as well as the knowledge and instruments needed for doing so, bringing in new incentives and governing instruments (van Erp et al, 2018).…”

“…Grouper software has been introduced in the Netherlands (as well as in other countries, yet with different decision rules due to variations in national systems) to standardise and facilitate hospital payments and to reduce the opportunities for upcoding, aiming for more 'outside' control on hospital payments. Physicians and hospital administrators, however, have stated that the grouper software has rendered the payment process too complex and error-sensitive, leading to remuneration errors and subsequent loss of income (van Erp et al, 2018). In this paper, we unpack the Dutch grouper system to gain insight into the incentives and possibilities for 'creative bookkeeping', as well as risks of income loss for both health insurers and health care providers in the Dutch grouper system.…”