Introducing the new DRG-based payment system in German hospitals: a difficult operation?

Wilke, Michael; Höcherl, E.; Scherer, Julian; Janke, Lois D.

doi:10.1007/pl00012221

Cited by 10 publications

(6 citation statements)

References 3 publications

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“…At the beginning of 2003, the German health care system changed its mechanism of hospital reimbursement from a per diem basis to a prospective diagnostic-related group (DRG) payment system [38]. Hence, if German hospitals are reimbursed a fixed amount for admission of a child with cerebral palsy by the Krankenkassen, then the lower the total management cost for the admission, the more surplus monies the hospital will accrue to invest in other resources.…”

Section: Discussionmentioning

confidence: 99%

Costs and consequences of botulinum toxin type A use

Ruiz

Guest

Lehmann

et al. 2004

Eur J Health Econom

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This study was a retrospective survey of the management of a cohort of children with cerebral palsy at Seepark Hospital, Germany, who did (cases; n=107) and did not (controls; n=107) receive botulinum toxin injections. Data on healthcare resource use and clinical outcomes over 12 months were collected from the date cases received their first injection and from the date controls were first admitted into hospital. Botulinum toxin use led to an 85% reduction in the number of children requiring surgery. Additionally, controls used significantly more healthcare resources than cases, particularly hospital bed days (69.2+/-34.1 vs. 27.5+/-27.9 days; p <0.0001). The total cost of managing cases and controls was 16,700 and 33,800, respectively. In conclusion, use of botulinum toxin released resources for alternative use during the first year following treatment, without any loss of clinical improvement. However, it is unknown how botulinum toxin affected the need for surgery and associated outcomes in subsequent years.

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Section: Discussionmentioning

confidence: 99%

Costs and consequences of botulinum toxin type A use

Ruiz

Guest

Lehmann

et al. 2004

Eur J Health Econom

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“…According to Scheller-Kreinsen et al (2009), unintended or adverse consequences may be observed in two dimensions: the quality of care and the documentation of service delivery. Wilke et al (2001) also recognize these two challenges. First, incorrect documentation can lead to improper grouping, faulty diagnosis, and incorrect reimbursements.…”

Section: The Drg System Its Uses and Abusesmentioning

confidence: 95%

Bending the Rules to Play the Game: Accountability, DRG and Waiting List Scandals in Norway and Germany

Neby¹,

Lægreid²,

Mattei³

et al. 2015

European Policy Analysis

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Diagnosis Related Groups (DRGs) are used for financial and administrative purposes in hospital systems across the world, and are combined with a series of administrative tools to increase efficiency and effectiveness. Economic dysfunctions of such systems are widely reported, but the organizational basis of this managerial tool and the implications for hospital governance are less explored. This article shows, through eight case studies, how DRGs and waiting list management create opportunities for gaming in Norway and Germany. It argues that whereas these effects are relatively similar, the way they are handled by different accountability types varies considerably between Norway and Germany. Despite similarities in gaming and accountability challenges in the single cases studied, the Norwegian and German systems seem to cope with gaming in different manners, as could be expected: The institutional context creates premises for resolving such issues that vary more with the actual governance setting than with the nature of a given case. Both systems are marked by a certain ambiguity and complexity defined by reforms history, institutional dynamics, and administrative traditions: the German legal‐oriented, Bismarckian system is as ambiguous as the Norwegian consensus‐oriented Beveridge‐type system.

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“…The concept of DRGs in the literature is almost exclusively tied to hospital services (Felder, 2009;Kuntz, Scholtes & Vera, 2008;Wilke, Höcherl, Scherer & Janke, 2001). It should be noted, however, that there are isolated publications which indicate the possibility of using it for ambulatory services (Averill et al, 1993;Baker, 2002;Duncan & Servais, 1996;Vitikainen et al, 2010).…”

Section: Literature Reviewmentioning

confidence: 96%

Ambulatory Patient Groups

Raulinajtys-Grzybek¹

2014

Paradigm: A Management Research Journal

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This article examines what potential effects the implementation of the payment system per "patient case" might have on the health service structure and providers' behaviour. Author analyzed the case of the pricing system of ambulatory services that was implemented in Poland in 2011. This system is based on the concept of ambulatory patient groups-the modification of diagnosis-related groups dedicated to the ambulatory health care. Improper design of grouping and pricing services-in particular, the lack of cost homogeneity and different level of profitability of different groups-may result in undesirable behaviours of providers, including, in particular, unjustified increasing or decreasing the number of services. The study shows that in recent years such undesirable phenomena occurred in Poland. In the case of most of the analyzed groups, the change in the price level resulted in the reaction of the providers that was significantly different from their behaviour in relation to other groups and/or behaviour in relation to tested variables in the period before the change in pricing.

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Introducing the new DRG-based payment system in German hospitals: a difficult operation?

Cited by 10 publications

References 3 publications

Costs and consequences of botulinum toxin type A use

Costs and consequences of botulinum toxin type A use

Bending the Rules to Play the Game: Accountability, DRG and Waiting List Scandals in Norway and Germany

Ambulatory Patient Groups

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