Using DRGs to Fund Hospitals in Portugal: An Evaluation of the Experience

Bentes, Margarida E.; Urbano, Joao A.; Carvalho, Maria do Carmo Brant de; Tranquada, Maria S.

doi:10.1007/978-3-642-78472-9_11

Cited by 11 publications

(6 citation statements)

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“…They verified that large urban hospitals have significantly more LOS outliers (5.6%) than medium size hospitals (4.6%) and small hospitals (3.6%). This result was previously shown by Bentes et al [ 16 ].…”

Section: Introductionsupporting

confidence: 90%

“…In Portugal it is used since 1990 [16] and has had positive impact on the productivity and technical efficiency of some diagnostic technologies [30]. …”

Section: Introductionmentioning

confidence: 99%

“…DRG (Diagnosis Related Groups) is the most commonly used case mix system for hospital reimbursement and performance measurement. In Portugal it is used since 1990 [ 16 ] and has had positive impact on the productivity and technical efficiency of some diagnostic technologies [ 30 ].…”

Section: Introductionmentioning

confidence: 99%

“…The Portuguese government is both the main payer and provider of hospital care. Originally, key components of the DRG based inpatient resource allocation model were the DRG weights, hospital case mix indexes, hospital blended base rates and total number of discharge equivalents [ 16 ]. The model includes adjustments to account for outliers (low and high) and transfer cases.…”

Section: Introductionmentioning

confidence: 99%

“…Bentes et al [ 16 ] described the experience with the use of DRGs to fund Portuguese hospitals and verified that between 1989 and 1990 the number of long-stay patients (high LOS outliers) increased (+2.59%). Nevertheless, they stated that the apparent increase could not be real because, for many DRGs, the threshold was set at low levels.…”

Section: Introductionmentioning

confidence: 99%

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Factors influencing hospital high length of stay outliers

Freitas

Silva-Costa

Lopes

et al. 2012

BMC Health Serv Res

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BackgroundThe study of length of stay (LOS) outliers is important for the management and financing of hospitals. Our aim was to study variables associated with high LOS outliers and their evolution over time.MethodsWe used hospital administrative data from inpatient episodes in public acute care hospitals in the Portuguese National Health Service (NHS), with discharges between years 2000 and 2009, together with some hospital characteristics. The dependent variable, LOS outliers, was calculated for each diagnosis related group (DRG) using a trim point defined for each year by the geometric mean plus two standard deviations. Hospitals were classified on the basis of administrative, economic and teaching characteristics. We also studied the influence of comorbidities and readmissions. Logistic regression models, including a multivariable logistic regression, were used in the analysis. All the logistic regressions were fitted using generalized estimating equations (GEE).ResultsIn near nine million inpatient episodes analysed we found a proportion of 3.9% high LOS outliers, accounting for 19.2% of total inpatient days. The number of hospital patient discharges increased between years 2000 and 2005 and slightly decreased after that. The proportion of outliers ranged between the lowest value of 3.6% (in years 2001 and 2002) and the highest value of 4.3% in 2009. Teaching hospitals with over 1,000 beds have significantly more outliers than other hospitals, even after adjustment to readmissions and several patient characteristics.ConclusionsIn the last years both average LOS and high LOS outliers are increasing in Portuguese NHS hospitals. As high LOS outliers represent an important proportion in the total inpatient days, this should be seen as an important alert for the management of hospitals and for national health policies. As expected, age, type of admission, and hospital type were significantly associated with high LOS outliers. The proportion of high outliers does not seem to be related to their financial coverage; they should be studied in order to highlight areas for further investigation. The increasing complexity of both hospitals and patients may be the single most important determinant of high LOS outliers and must therefore be taken into account by health managers when considering hospital costs.

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Section: Introductionsupporting

confidence: 90%

“…In Portugal it is used since 1990 [16] and has had positive impact on the productivity and technical efficiency of some diagnostic technologies [30]. …”

Section: Introductionmentioning

confidence: 99%