2020
DOI: 10.1007/s10754-020-09287-x
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From downcoding to upcoding: DRG based payment in hospitals

Abstract: A prospective disease group-based payment is a reimbursement rule used in a wide array of countries. It turns to be the hospital's payment rule to imply. The secret of this payment is a fee payment as well as a hospital's activity based payment. There is a consensus to consider this rule of payment as the least likely to be manipulated by the actors. However, the defined fee per group depends on recorded information that is then processed using complex algorithms. What if the data itself can be manipulated? Th… Show more

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Cited by 15 publications
(9 citation statements)
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References 29 publications
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“…Earlier research on upcoding has either been on aggregate levels, within specific DRGs, or focused on one-off exogenous shifts in prices (Anthun et al, 2017 ; Barros & Braun, 2016 ; Dafny, 2005 ; Milcent, 2021 ; Silverman & Skinner, 2004 ). Our main hypothesis in this paper follows common economic theory that incentives do work.…”
Section: Introductionmentioning
confidence: 99%
“…Earlier research on upcoding has either been on aggregate levels, within specific DRGs, or focused on one-off exogenous shifts in prices (Anthun et al, 2017 ; Barros & Braun, 2016 ; Dafny, 2005 ; Milcent, 2021 ; Silverman & Skinner, 2004 ). Our main hypothesis in this paper follows common economic theory that incentives do work.…”
Section: Introductionmentioning
confidence: 99%
“…1 It must be noted that price increases might not only lead to increases in quantity or quality of services, but can also trigger upcoding (Shin, 2019 ). Health systems dominated by public providers can also be prone to upcoding, as demonstrated in, for example, France (Milcent, 2021 ), Portugal (Barros & Braun, 2017 ) or Norway (Anthun, 2022 ; Januleviciute et al, 2016 ), however, the effect seems to be moderate.…”
Section: Related Literaturementioning
confidence: 99%
“…It is logical this will enhance a focus on costly elements of perioperative and surgical care delivery and especially mechanisms to reduce costly complications discussed previously. There is a risk such mechanisms encourage undesirable responses such as upcoding to maximise provider returns [ 87 , 88 ••], case selection (“cream skimming”), collusion, skimping, or laying off costs to others [ 89 , 90 ]. Concerns around skimping are often voiced by clinicians.…”
Section: Institution Of Cost Managementmentioning
confidence: 99%