Medicare’s DRG-weights in a European environment: The Spanish experience

Health Policy

Volumn 51, Issue 1, 2000, Pages 31-47

  Cots, Francesc ^a   Elvira, David ^a   Castells, Xavier ^a   Dalmau, Eulalia ^a  

^a HOSPITAL DEL MAR   (Spain)

Author keywords

Diagnosis Related Groups; DRG weights; Hospital Cost; Hospital Payment Systems

Indexed keywords

ARTICLE; CONTROLLED STUDY; DIAGNOSIS RELATED GROUP; HEALTH CARE COST; HEALTH CARE FINANCING; HEALTH CARE SYSTEM; HOSPITAL; MEDICARE; PROSPECTIVE PAYMENT; REIMBURSEMENT; SPAIN;

ACCOUNTING; COST ALLOCATION; DIAGNOSIS-RELATED GROUPS; HOSPITALS, PUBLIC; MEDICARE; NATIONAL HEALTH PROGRAMS; PROSPECTIVE PAYMENT SYSTEM; SPAIN; UNITED STATES; UNITED STATES CENTERS FOR MEDICARE AND MEDICAID SERVICES;

EID: 0033951551     PISSN: 01688510     EISSN: None     Source Type: Journal    
DOI: 10.1016/S0168-8510(99)00074-3     Document Type: Article

References (58)

1. Pellisé L. Financiación de proveedores sanitarios e intermediarios financieros: una taxonomía. Hacienda Pública Española. 1:1993;33-44.
2. Generalitat de Catalunya. Departament de Sanitat i Benestar Social. Decret 179/1997 de 22 de Juliol. Diari Oficial de la Generalitat de Catalunya 1997;2445:8720-8721.
3. Newhouse J.P. Reimbursing health plans and health providers: efficiency in production versus selection. Journal of Economic Literature. 34:1996;1236-1263.
4. Magnussen J., Solstad K. Case-based hospital financing: the case of Norway. Health Policy. 28:1994;23-36.
5. Ellis R.P., McGuire T.G. Provider behavior under prospective reimbursement. Journal of Health Economics. 5:1986;129-151.
6. Rhodes G., Wiley M., Tomas R., Casas M., Leidl R. Comparing EU hospital efficiency using diagnosis-related groups. European Journal of Public Health. 7(3):1997;42-50.
7. Casas M. Sistemes d'informació hospitalària basats en la casuística: grups relacionats amb el diagnòstic. Impacte en la gestió hospitalària. Thesis doctoral. Barcelona 1990.
8. Cots F., Castells X., Garcia A., Saez M. Relación de los costes directos de hospitalización con la duración de la estancia. Gaceta Sanitaria. 11(6):1997;287-295.
9. Ibern P., Bisbel J., Casas M. The development of cost information by DRG. Experience in a Barcelona hospital. Health Policy. 17:1991;179-194.
10. Wiley M.M. Costing hospital case-mix: the European experience. Casas M., Wiley M.M. Diagnosis Related Groups in Europe. Uses and perspectives. 1993;Springer-Verlag, Berlin.
11. Bentes M.E., Urbano J.A., Carvalho M.C., Tranquada M.S. Using DRGs to found hospitals in Portugal: an evaluation experience. Casas M., Wiley M.M. Diagnosis related groups in Europe. Uses and Perspectives. 1993;Springer-Verlag, Berlin.
12. Söderlund N., Gray A., Milne R., Raftery J. Case mix measurement in English hospitals: an evaluation of five methods for predicting resource use. Journal of Health Services Research and Policy. 1(1):1996;10-19.
13. Söderlund N., Gray A., Milne R., Raftery J. Differences in hospital casemix, and the relationship between casemix and hospital costs. Journal of Public Health Medicine. 17(1):1995;25-32.
14. Söderlund N. Product definition for healthcare contracting: an overview of approaches to measuring hospital output with reference to the UK internal market. Journal of Epidemiology Community Health. 48(3):1994;224-231.
15. Sanderson H.F., Anthony P., Mountney L.M. Healthcare Resource Groups. Version 2. Journal of Public Health Medicine. 17(3):1995;349-354.
16. Duckett S.J. Hospital payment arrangements to encourage efficiency: the case of Victoria, Australia. Health Policy. 34:1995;113-134.
17. Street A., Duckett S. Are waiting lists inevitable. Health Policy. 36:1996;1-15.
18. Pink G.H., Bolley H.B. Physicians in health care management: 4. Case mix groups and resource intensity weights: physicians and hospital funding. Canadian Medical Association Journal. 8:1994;1255-1261.
19. Fetter R.B., Brand D., Gammache D. DRGs:their design and development. 1991;Health Administration Press, Michigan.
20. Carter G.M., Jacobson P.D., Kominski G.F., Perry M.J. Use of diagnosis-related groups by non-Medicare payers. Health Care Financing Review. 16(2):1994;127-158.
21. Pope G.C. Using hospital specific costs to improve the fairness of prospective reimbursement. Journal of Health Economics. 9:1990;237-251.
22. Goody B., Friedman M.A., Sobaski W. New directions for medicare payment systems. Health Care Financing Review. 16(2):1994;1-11.
23. Shwarts W., Mendelson D. Hospital cost containment in the 1980s. Hard lessons learned and prospects for 1990s. New England Journal of Medicine. 234(15):1991;1037-1042.
24. Ellis R.P. Creaming, skimping and dumping: provider competition on intensive and extensive margins. Journal of Health Economics. 17(5):1998;511-644.
25. Sulvetta MB. Achieving cost control in the hospital outpatient department. Health Care Financing Review 1991;(Annual supplement):95-106.
26. Lion J., Vertrees J., Malbon A., Collard A., Mowschenson P. Toward a prospective payment system for ambulatory surgery. Health Care Financing Review. 11(3):1990;79-86.
27. Altman S.H. Measuring real case mix change under Medicare's prospective payment system (editorial). Journal of Health Economics. 9(499):1990;504.
28. Espinàs J.A., Borras J.M., Colomer J., Ramon C., Varela J. Estimation of potential impact of ambulatory surgery in Catalonia. Medicina Clínica. 109(3):1997;81-84.
29. Esteva M.T. Programa de cirugía mayor ambulatoria: consolidación y resultados (resumen). Gestión Hospitalaria. 1:1995;49-52.
30. Miller M.E., Sulvetta M.B. Growth in Medicare's hospital outpatient care: implications for prospective payment. Inquiry. 32(2):1995;155-163.
31. Sulvetta MB Achieving cost control in the hospital outpatient department. Health Care Financing Review 1991;(Annual suplement): 95-106.
32. Chan L., Koepsell T.D., Deyo R.A., Esselman P.C. The effect of medicare's payment system for rehabilitation hospitals on length of stay, charges, and total payments. The New England Journal of Medicine. 337(14):1997;978-985.
33. Schlenker R.E., Kramer A.M., Hrincevich C.A., Eilertsen B. Rehabilitation costs: implications for prospective payment. Health Service Research. 32(5):1997;651-668.
34. Zwangzinger J., Davis L., Bamezai A., Hosek S.D. Using DRGs to pay for inpatient substance abuse services: an assessment of the CHAMPUS reimbursement system. Medical Care. 29(6):1991;565-577.
35. Westphalen J.B. Diagnosis related groups: The effect of input error. Australian Clinical Review. 13:1993;127-131.
36. Thorpe K.E., Cretin S., Keeler E.B. Are the diagnosis-related group case weights compressed. Health Care Financing Review. 10(2):1988;37-46.
37. Carter G.M., Rogowski J.A. How recalibration method, pricing, and coding affect DRG weights. Health Care Financing Review. 14(2):1992;83-96.
38. Temes J.L., Díaz J.L., Parra B. El Coste por Proceso Hospitalario. 1994;Editorial interamericana McGraw-Hill, Madrid.
39. Guadalaja N. Análisis de Costes en los Hospitales. 1994;MCQ Ediciones, Valencia.
40. Bisbe J. Modelos de costes y bases de datos: opciones para el cálculo del consumo de recursos por GRD. Casas M Los Grupos relacionados por el diagnóstico (GRD): Experiencia y Perspectivas de Utilización. 1991;Masson SA, Barcelona.
41. Udpa S. Activity-based costing for hospitals. Health Care Management Review. 21(3):1996;83-96.
42. Young D.W., Pearlman L.K Management accounting in hospitals: lessons from manufacturing. Casas M., Wiley M.M. Diagnosis related groups in Europe. Uses and prespectives. 1993;Springer-Verlag, Berlin.
43. Carter GM, Rumpel JD. Payment rates for unusual Medicare hospital cases. RAND, 1992.
44. Casas M. Los Grupos relacionados con el Diagnóstico: Experiencia y Perspectivas de Utilización. 1991;Masson, S.A, Barcelona.
45. Lichtig L. Hospital information systems for case mix management. 1986;Wiley, New York.
46. Cots F. Sistema de pago prospectivo por GRD. Riesgo finanaciero generado por la existencia de casos extremos. Final report- project 1351/1996 of FIS 1999.
47. Beaver C., Zhao Y., McDermid S., Hindle D. Casemix-based funding of northern territory public hospitals: adjusting for severity and socio-economic variations. Health Economics. 7:1998;53-61.
48. Servei Català de la Salut. Memòria d'activitat 1996. Barcelona: Servei Català de la Salut, 1997.
49. Morey R.C., Ozcan Y.A., Retzlaff-Roberts D.L., Fine D.J. Estimating the hospital-wide cost differentials warranted for teaching hospitals. Medical Care. 33(5):1995;531-552.
50. Ibern P., Vertrees J.C., Manton K.G., Woodbury M.A. Hospital groups and case-mix measurement for resource allocation and payment. Casas M., Wiley M.M. Diagnosis related groups in Europe. Uses and perspectives. 1993;Springer-Verlag, Berlin.
51. O'Dougherty S.M., Cotterill P.G., Phillips S., Richter E., De Lew N., Wynn B. et al. Medicare prospective payment without separate urban and rural rates. Health Care Financing Review. 14(2):1992;31-47.
52. Farley D.E., Hogan C. Case-mix specialization in the market for hospital services. Health Services Research. 25:1990;757-783.
53. Institut Municipal d'Assistència Sanitària. Memòria 1997. Barcelona: IMAS, 1998.
54. Miller M.E., Sulvetta M.B., Englert E. Service mix in the hospital outpatient department: implications for Medicare payment reform. Health Services Research. 30(1):1995;60-78.
55. Goldfield N. Ambulatory encounter systems: implications for payment and quality. Journal of Ambulatory Care Management. 16(2):1993;33-49.
56. Ellis R.P., McGuire T.G. Hospital response to prospective payment: moral hazard, selection, and practice-style effects. Journal of Health Economics. 15:1996;257-277.
57. McClellan M. Hospital reimbursement incentives:an empirical analysis. Journal of Economics and Management strategy. 6(1):1997;91-128.
58. Wiley M.M. Hospital financing reform and casemix measurement: an international review. Health Care Financing Review. 14(4):1992;119-133.