How Denmark, England, Estonia, France, Germany, and the USA Pay for Variable, Specialized and Low Volume Care: A Cross-country Comparison of In-patient Payment Systems
Background Diagnosis-related group (DRG)-based hospital payment can potentially be inadequately low (or high) for highly variable, highly specialized, and/or low volume care. DRG-based payment can be combined with other payment mechanisms to avoid unintended consequences of inadequate payment. The...
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| Format: | Article |
| Language: | English |
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Kerman University of Medical Sciences
2022-12-01
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| Series: | International Journal of Health Policy and Management |
| Subjects: | |
| Online Access: | https://www.ijhpm.com/article_4255_0484a5590215857331fa8e935f97e447.pdf |
| _version_ | 1811158674949799936 |
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| author | Wilm Quentin Victor Stephani Robert A. Berenson Lone Bilde Katja Grasic Riina Sikkut Mariama Touré Alexander Geissler |
| author_facet | Wilm Quentin Victor Stephani Robert A. Berenson Lone Bilde Katja Grasic Riina Sikkut Mariama Touré Alexander Geissler |
| author_sort | Wilm Quentin |
| collection | DOAJ |
| description | Background Diagnosis-related group (DRG)-based hospital payment can potentially be inadequately low (or high) for highly variable, highly specialized, and/or low volume care. DRG-based payment can be combined with other payment mechanisms to avoid unintended consequences of inadequate payment. The aim of this study was to analyze these other payment mechanisms for acute inpatient care across six countries (Germany, Denmark, England, Estonia, France, the United States [Medicare]).Methods Information was collected about elements excluded from DRG-based payment, the rationale for exclusions, and payment mechanisms complementing DRG-based payment. A conceptual framework was developed to systematically describe, visualise and compare payment mechanisms across countries.Results Results show that the complexity of exclusion mechanisms and associated additional payment components differ across countries. England and Germany use many different additional mechanisms, while there are only few exceptions from DRG-based payment in the Medicare program in the United States. Certain areas of care are almost always excluded (eg, certain areas of cancer care or specialized pediatrics). Denmark and England use exclusion mechanisms to steer service provision for highly complex patients to specialized providers.Conclusion Implications for researchers and policy-makers include: (1) certain areas of care might be better excluded from DRG-based payment; (2) exclusions may be used to incentivize the concentration of highly specialized care at specialized institutions (as in Denmark or England); (3) researchers may apply our analytical framework to better understand the specific design features of DRG-based payment systems. |
| first_indexed | 2024-04-10T05:28:09Z |
| format | Article |
| id | doaj.art-8d64e653c37141b18ab7d3226db2625a |
| institution | Directory Open Access Journal |
| issn | 2322-5939 |
| language | English |
| last_indexed | 2024-04-10T05:28:09Z |
| publishDate | 2022-12-01 |
| publisher | Kerman University of Medical Sciences |
| record_format | Article |
| series | International Journal of Health Policy and Management |
| spelling | doaj.art-8d64e653c37141b18ab7d3226db2625a2023-03-07T09:12:01ZengKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59392022-12-0111122940295010.34172/ijhpm.2022.65364255How Denmark, England, Estonia, France, Germany, and the USA Pay for Variable, Specialized and Low Volume Care: A Cross-country Comparison of In-patient Payment SystemsWilm Quentin0Victor Stephani1Robert A. Berenson2Lone Bilde3Katja Grasic4Riina Sikkut5Mariama Touré6Alexander Geissler7Department of Health Care Management, Technische Universität Berlin, Berlin, GermanyHelloBetter, Berlin, GermanyThe Urban Institute, Health Policy Center, Washington, DC, USADanish Institute for Applied Social Sciences Research, Copenhagen, DenmarkCentre for Health Economics, University of York, York, UKThe Estonian Parliament, Tallinn, EstoniaPoverty, Health and Nutrition Division (PHND), International Food Policy Research Institute (IFPRI), Washington, DC, USASchool of Medicine, University of St. Gallen, St. Gallen, SwitzerlandBackground Diagnosis-related group (DRG)-based hospital payment can potentially be inadequately low (or high) for highly variable, highly specialized, and/or low volume care. DRG-based payment can be combined with other payment mechanisms to avoid unintended consequences of inadequate payment. The aim of this study was to analyze these other payment mechanisms for acute inpatient care across six countries (Germany, Denmark, England, Estonia, France, the United States [Medicare]).Methods Information was collected about elements excluded from DRG-based payment, the rationale for exclusions, and payment mechanisms complementing DRG-based payment. A conceptual framework was developed to systematically describe, visualise and compare payment mechanisms across countries.Results Results show that the complexity of exclusion mechanisms and associated additional payment components differ across countries. England and Germany use many different additional mechanisms, while there are only few exceptions from DRG-based payment in the Medicare program in the United States. Certain areas of care are almost always excluded (eg, certain areas of cancer care or specialized pediatrics). Denmark and England use exclusion mechanisms to steer service provision for highly complex patients to specialized providers.Conclusion Implications for researchers and policy-makers include: (1) certain areas of care might be better excluded from DRG-based payment; (2) exclusions may be used to incentivize the concentration of highly specialized care at specialized institutions (as in Denmark or England); (3) researchers may apply our analytical framework to better understand the specific design features of DRG-based payment systems.https://www.ijhpm.com/article_4255_0484a5590215857331fa8e935f97e447.pdfprospective payment systemreimbursement mechanismshealthcare financinginternational comparisontertiary healthcare |
| spellingShingle | Wilm Quentin Victor Stephani Robert A. Berenson Lone Bilde Katja Grasic Riina Sikkut Mariama Touré Alexander Geissler How Denmark, England, Estonia, France, Germany, and the USA Pay for Variable, Specialized and Low Volume Care: A Cross-country Comparison of In-patient Payment Systems International Journal of Health Policy and Management prospective payment system reimbursement mechanisms healthcare financing international comparison tertiary healthcare |
| title | How Denmark, England, Estonia, France, Germany, and the USA Pay for Variable, Specialized and Low Volume Care: A Cross-country Comparison of In-patient Payment Systems |
| title_full | How Denmark, England, Estonia, France, Germany, and the USA Pay for Variable, Specialized and Low Volume Care: A Cross-country Comparison of In-patient Payment Systems |
| title_fullStr | How Denmark, England, Estonia, France, Germany, and the USA Pay for Variable, Specialized and Low Volume Care: A Cross-country Comparison of In-patient Payment Systems |
| title_full_unstemmed | How Denmark, England, Estonia, France, Germany, and the USA Pay for Variable, Specialized and Low Volume Care: A Cross-country Comparison of In-patient Payment Systems |
| title_short | How Denmark, England, Estonia, France, Germany, and the USA Pay for Variable, Specialized and Low Volume Care: A Cross-country Comparison of In-patient Payment Systems |
| title_sort | how denmark england estonia france germany and the usa pay for variable specialized and low volume care a cross country comparison of in patient payment systems |
| topic | prospective payment system reimbursement mechanisms healthcare financing international comparison tertiary healthcare |
| url | https://www.ijhpm.com/article_4255_0484a5590215857331fa8e935f97e447.pdf |
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