Development of a simulation program for estimating hospital incomes under the prospective payment system

Abe, Toshikazu; Toyabe, Shin-ichi; Cao, Pengyu; Kurashima, Sachiko; Akazawa, Kouhei

doi:10.1016/j.cmpb.2005.09.003

Cited by 9 publications

(7 citation statements)

References 10 publications

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“…Length of stay (LOS) is an important measure of resource utilization and, naturally, there are several systems for modelling and predicting LOS [7-10]. …”

Section: Introductionmentioning

confidence: 99%

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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“…Length of stay (LOS) is an important measure of resource utilization and, naturally, there are several systems for modelling and predicting LOS [7-10]. …”

Section: Introductionmentioning

confidence: 99%

Factors influencing hospital high length of stay outliers

Freitas

Silva-Costa

Lopes

et al. 2012

BMC Health Serv Res

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“…Therefore, hospitals in percentiles 0–25 might be likely to increase their ALOS up to the nationwide threshold value of the 25th percentile. Indeed, given the capability of sustaining high bed occupancy rate (Abe et al ., ), hospitals in percentiles 0–25 are indifferent between admitting a new patient or treating a patient who is already in hospital for longer. As for percentiles 26–50 of ALOS, a part of hospitals that cannot decrease their ALOS up to the value of the 25th percentile might increase it up to the value of the mean nationwide ALOS.…”

Section: Methodsmentioning

confidence: 99%

Differential Effects of Declining Rates in a Per Diem Payment System

Besstremyannaya

2014

Health Economics

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The paper demonstrates differential effects of a prospective payment system with declining per diem rates, dependent on the percentiles of length of stay. The analysis uses dynamic panel data estimates and a recent nationwide administrative database for major diagnostic categories in 1068 Japanese hospitals in 2006-2012 to show that average length of stay significantly increases for hospitals in percentiles 0-25 of the pre-reform length of stay and significantly decreases for hospitals in percentiles 51-100. The decline of the average length of stay is larger for hospitals in higher percentiles of the length of stay. Hospitals in percentiles 51-100 significantly increase their rate of nonemergency/unanticipated readmissions within 42 days after discharge. The decline in the length of total episode of treatment is smaller for hospitals in percentiles 0-25. The findings are robust in terms of the choice of a cohort of hospitals joining the reform. The paper discusses applicability of 'best practice' rate-setting to help improve the performance of hospitals in the lowest quartile of average length of stay. Copyright © 2015 John Wiley & Sons, Ltd.

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“…The National Health Insurance Authority (NHIA) commits to address this challenge through provider payment reforms with the view to containing cost while asuring quality of care. This decision syncs with evidence in literature which indicates that one key motivation for provider payment reforms in countries’ health system is the need for countries to improve efficiency in the application of health care resource in order to contain cost escalation without compromising quality [ 7 – 9 ]. Economic theory, however, points to the fact that changes in provider payment methods elicits responses from health care providers that could negatively affect the quality and quantity of service they provide [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of capitation payment on utilization and claims expenditure under National Health Insurance Scheme: a cross-sectional study of three regions in Ghana

Andoh-Adjei¹,

Boudewijns²,

Nsiah-Boateng³

et al. 2018

Health Econ Rev

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IntroductionGhana introduced capitation payment under National Health Insurance Scheme (NHIS), beginning with pilot in the Ashanti region, in 2012 with a key objective of controlling utilization and related cost. This study sought to analyse utilization and claims expenditure data before and after introduction of capitation payment policy to understand whether the intended objective was achieved.MethodsThe study was cross-sectional, using a non-equivalent pre-test and post-test control group design. We did trend analysis, comparing utilization and claims expenditure data from three administrative regions of Ghana, one being an intervention region and two being control regions, over a 5-year period, 2010–2014. We performed multivariate analysis to determine differences in utilization and claims expenditure between the intervention and control regions, and a difference-in-differences analysis to determine the effect of capitation payment on utilization and claims expenditure in the intervention region.ResultsFindings indicate that growth in outpatient utilization and claims expenditure increased in the pre capitation period in all three regions but slowed in post capitation period in the intervention region. The linear regression analysis showed that there were significant differences in outpatient utilization (p = 0.0029) and claims expenditure (p = 0.0003) between the intervention and the control regions before implementation of the capitation payment. However, only claims expenditure showed significant difference (p = 0.0361) between the intervention and control regions after the introduction of capitation payment. A difference-in-differences analysis, however, showed that capitation payment had a significant negative effect on utilization only, in the Ashanti region (p < 0.007). Factors including availability of district hospitals and clinics were significant predictors of outpatient health care utilization.ConclusionWe conclude that outpatient utilization and related claims expenditure increased in both pre and post capitation periods, but the increase in post capitation period was at slower rate, suggesting that implementation of capitation payment yielded some positive results. Health policy makers in Ghana may, therefore, want to consider capitation a key provider payment method for primary outpatient care in order to control cost in health care delivery.Electronic supplementary materialThe online version of this article (10.1186/s13561-018-0203-9) contains supplementary material, which is available to authorized users.

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Development of a simulation program for estimating hospital incomes under the prospective payment system

Cited by 9 publications

References 10 publications

Factors influencing hospital high length of stay outliers

Factors influencing hospital high length of stay outliers

Differential Effects of Declining Rates in a Per Diem Payment System

Effects of capitation payment on utilization and claims expenditure under National Health Insurance Scheme: a cross-sectional study of three regions in Ghana

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