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

Longo, Francesco; Siciliani, Luigi; Street, Andrew

doi:10.1007/s10198-017-0935-1

Cited by 3 publications

(2 citation statements)

References 21 publications

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“…The ratio of admissions from outside of the canton of hospitals was designed to assess the association between hospital costs and the specialization of hospitals as indicated by the proportion of patients arriving from outside of the canton to make use of the specialized services that hospitals provide. This reasoning is based on the fact that previous studies [ 23 ] have shown higher costs in certain specialty hospitals and the finding that this variable has proven to be the best variable to distinguish hospitals within the highly diverse group of specialty clinics. It may be argued that some specialty clinics can specialize in relatively high-volume (low risk) procedures directed towards a large enough pool of patients (i.e., receive enough patients from within their own canton).…”

Section: Discussionmentioning

confidence: 99%

Identification and assessment of a comprehensive set of structural factors associated with hospital costs in Switzerland

Havranek¹,

Ondrej²,

Bollmann³

et al. 2022

PLoS ONE

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Structural factors can influence hospital costs beyond case-mix differences. However, accepted measures on how to distinguish hospitals with regard to cost-related organizational and regional differences are lacking in Switzerland. Therefore, the objective of this study was to identify and assess a comprehensive set of hospital attributes in relation to average case-mix adjusted costs of hospitals. Using detailed hospital and patient-level data enriched with regional information, we derived a list of 23 cost predictors, examined how they are associated with costs, each other, and with different hospital types, and identified principal components within them. Our results showed that attributes describing size, complexity, and teaching-intensity of hospitals (number of beds, discharges, departments, and rate of residents) were positively related to costs and showed the largest values in university (i.e., academic teaching) and central general hospitals. Attributes related to rarity and financial risk of patient mix (ratio of rare DRGs, ratio of children, and expected loss potential based on DRG mix) were positively associated with costs and showed the largest values in children’s and university hospitals. Attributes characterizing the provision of essential healthcare functions in the service area (ratio of emergency/ ambulance admissions, admissions during weekends/ nights, and admissions from nursing homes) were positively related to costs and showed the largest values in central and regional general hospitals. Regional attributes describing the location of hospitals in large agglomerations (in contrast to smaller agglomerations and rural areas) were positively associated with costs and showed the largest values in university hospitals. Furthermore, the four principal components identified within the hospital attributes fully explained the observed cost variations across different hospital types. These uncovered relationships may serve as a foundation for objectifying discussions about cost-related heterogeneity in Swiss hospitals and support policymakers to include structural characteristics into cost benchmarking and hospital reimbursement.

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Section: Discussionmentioning

confidence: 99%

Identification and assessment of a comprehensive set of structural factors associated with hospital costs in Switzerland

Havranek¹,

Ondrej²,

Bollmann³

et al. 2022

PLoS ONE

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“…Meanwhile, in the United States using an honorarium mechanism based on the specialty of its hospitals by distinguishing itself from General Hospitals. This means that Specialist Doctors are only available in Specialist Hospitals based on their specialization [28].…”

Section: Functionalization Of Deconstructive Theory In Conducting Bin...mentioning

confidence: 99%

Equality of Justice for Honorarium Differences in Carrying out the Medical Profession: Binary Contamination Efforts

Solichien

2023

Advances in Social Science, Education and Humanities Research

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The state of binary opposition in every social relationship is one of the causes of the emergence of injustice in the effort to obtain a decent livelihood. The loss of equality of justice in achieving a decent livelihood -in carrying out the process of specialist doctors, is precisely caused by the imbalance in the formulation of legal norms legitimized by power through the activities of forming laws and regulations based on monologue reasoning. Until, there is an inequality between one Specialist Doctor and another Specialist, just because it works non-linearly in a hospital that has certain specialties. This study aims to analyze the government's injustice in determining income in the form of honorarium for specialist doctors in hospitals labeled Special Hospitals in Indonesia. The problem to be studied in this study is related to efforts to carry out binary contamination of the discourse of honorarium inequality among fellow specialists. This research uses legal research methods with a multidisciplinary approach, namely a legal approach and a socio-political science approach. The results of this study show a difference in honorarium payments for fellow doctors who have the status of specialist doctors and work in government special hospitals by designating non-specialist doctors based on the specificity of the hospital specialties as marginalized binary opposition through the Minister of Health Regulation. The Minister of Health Regulation is a symbolic dominance for Specialist Doctors who work in Special Hospitals but is not linear with their specificity.

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Gap in funding for specialist hospitals treating patients with traumatic spinal cord injury under an activity-based funding model in New South Wales, Australia

Vaikuntam¹,

Middleton²,

McElduff

et al. 2020

Aust. Health Review

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ObjectiveThe aim of this study was to estimate the difference between treatment costs in acute care settings and the level of funding public hospitals would receive under the activity-based funding model. MethodsPatients aged ≥16 years who had sustained an incident traumatic spinal cord injury (TSCI) between June 2013 and June 2016 in New South Wales were included in the study. Patients were identified from record-linked health data. Costs were estimated using two approaches: (1) using District Network Return (DNR) data; and (2) based on national weighted activity units (NWAU) assigned to activity-based funding activity. The funding gap in acute care treatment costs for TSCI patients was determined as the difference in cost estimates between the two approaches. ResultsOver the study period, 534 patients sustained an acute incident TSCI, accounting for 811 acute care hospital separations within index episodes. The total acute care treatment cost was estimated at A$40.5 million and A$29.9 million using the DNR- and NWAU-based methods respectively. The funding gap in total costs was greatest for the specialist spinal cord injury unit (SCIU) colocated with a major trauma service (MTS), at A$4.4 million over the study period. ConclusionsThe findings of this study suggest a substantial gap in funding for resource-intensive patients with TSCI in specialist hospitals under current DRG-based funding methods. What is known about the topic?DRG-based funding methods underestimate the treatment costs at the hospital level for patients with complex resource-intensive needs. This underestimation of true direct costs can lead to under-resourcing of those hospitals providing specialist services. What does this paper add?This study provides evidence of a difference between true direct costs in acute care settings and the level of funding hospitals would receive if funded according to the National Efficient Price and NWAU for patients with TSCI. The findings provide evidence of a shortfall in the casemix funding to public hospitals under the activity-based funding for resource-intensive care, such as patients with TSCI. Specifically, depending on the classification system, the principal referral hospitals, the SCIU colocated with an MTS and stand-alone SCIU were underfunded, whereas other non-specialist hospitals were overfunded for the acute care treatment of patients with TSCI. What are the implications for practitioners?Although health care financing mechanisms may vary internationally, the results of this study are applicable to other hospital payment systems based on diagnosis-related groups that describe patients of similar clinical characteristics and resource use. Such evidence is believed to be useful in understanding the adequacy of hospital payments and informing payment reform efforts. These findings may have service redesign policy implications and provide evidence for additional loadings for specialist hospitals treating low-volume, resource-intensive patients.

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

Cited by 3 publications

References 21 publications

Identification and assessment of a comprehensive set of structural factors associated with hospital costs in Switzerland

Identification and assessment of a comprehensive set of structural factors associated with hospital costs in Switzerland

Equality of Justice for Honorarium Differences in Carrying out the Medical Profession: Binary Contamination Efforts

Gap in funding for specialist hospitals treating patients with traumatic spinal cord injury under an activity-based funding model in New South Wales, Australia

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