Paying for hospital care: The experience with implementing activity-based funding in five European Countries

Health Economics, Policy and Law

Volumn 7, Issue 1, 2012, Pages 73-101

  O'Reilly, Jacqueline ^a   Busse, Reinhard ^b   Häkkinen, Unto ^c   Or, Zeynep ^d   Street, Andrew ^e   Wiley, Miriam ^f  

^a ECONOMIC AND SOCIAL RESEARCH INSTITUTE   (Ireland)

^b TECHNISCHE UNIVERSITÄT BERLIN   (Germany)

^c NATIONAL PUBLIC HEALTH INSTITUTE   (Finland)

^d Institute for Research and Information in Health Economics   (France)

^e UNIVERSITY OF YORK   (United Kingdom)

^f ECONOMIC AND SOCIAL RESEARCH INSTITUTE   (Ireland)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; BUDGET; COST CONTROL; EVIDENCE BASED MEDICINE; FINLAND; FRANCE; FUNDING; GERMANY; HEALTH CARE PLANNING; HEALTH CARE QUALITY; HOSPITAL CARE; HOSPITAL COST; HOSPITAL RUNNING COST; HUMAN; INTERMETHOD COMPARISON; IRELAND; LENGTH OF STAY; MOTIVATION; OUTCOME ASSESSMENT; PERSONAL EXPERIENCE; PRIORITY JOURNAL; PROCESS DEVELOPMENT; REIMBURSEMENT; UNITED KINGDOM;

CROSS-CULTURAL COMPARISON; ECONOMICS, HOSPITAL; ENGLAND; EUROPE; FINANCIAL MANAGEMENT, HOSPITAL; FINLAND; FRANCE; GERMANY; HUMANS; IRELAND; REIMBURSEMENT MECHANISMS;

EID: 84855678658     PISSN: 17441331     EISSN: 1744134X     Source Type: Journal    
DOI: 10.1017/S1744133111000314     Document Type: Article

References (99)

1. Aas, I. H. M. (1995), 'Incentives and financing methods', Health Policy, 34(3): 205-220.
2. Audit Commission (2008a), PbR Data Assurance Framework 2007/08. Findings from the First Year of the National Clinical Coding Audit Programme, London: Audit Commission. Audit Commission (2008b), The Right Result? Payment by Results 2003-07, London: Audit Commission.
3. Audit Commission (2009), PbR Data Assurance Framework 2008/09. Key Messages from Year 2 of the National Clinical Coding Audit Programme, London: Audit Commission.
4. Audit Commission (2010), Improving Data Quality in the NHS: Annual Report of the PbR Assurance Programme, London: Audit Commission
5. Bellanger, M. M. and L. Tardif (2006), 'Accounting and reimbursement schemes for inpatient care in France', Health Care Management Science, 9(3): 295-305. (Pubitemid 44202031)
6. Bö cking, W., U. Ahrens, W. Kirch and M. Milakovic (2005), 'First results of the introduction of DRGs in Germany and overview of experience from other DRG countries', Journal of Public Health, 13(3): 128-137. (Pubitemid 40894627)
7. Boyle, S. (2005), 'Payment by results in England', Euro Observer, 7(4): 1-4.
8. Brick, A., A. Nolan, J. O'Reilly and S. Smith (2010), Resource Allocation, Financing and Sustainability in Health Care: Evidence for the Expert Group on Resource Allocation and Financing in the Health Sector, Dublin: Department of Health and Children and Economic and Social Research Institute
9. Busse, R., A. Geissler, W. Quentin and M. Wiley (eds) (2011), Diagnosis Related Groups in Europe. Moving Towards Transparency, Efficiency and Quality in Hospitals, Maidenhead: Open University Press
10. Busse, R. and A. Riesberg (2004), Health Care Systems in Transition: Germany, Copenhagen: WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies.
11. Busse, R., J. Schreyö gg and P. C. Smith (2006), 'Editorial: Hospital case payment systems in Europe', Health Care Management Science, 9(3): 211-213. (Pubitemid 44198205)
12. Clarke, A. (1996), 'Why are we trying to reduce length of stay? Evaluation of the costs and benefits of reducing time in hospital must start from the objectives that govern change', Quality in Health Care, 5(3): 172-179. (Pubitemid 126509598)
13. Commission on Health Funding (1989), Report of the Commission on Health Funding, Dublin: The Stationery Office.
14. Daidone, S. and A. Street (2011), Estimating the Costs of Specialised Care. CHE Research Paper 61, York: University of York.
15. Department of Health (2007), 'Payment by Results Guidance 2008/09', http://www.dh. gov.uk/prod-consum-dh/groups/dh-digitalassets/@dh/@en/documents/ digitalasset/dh- 081334.pdf [4 March 2011].
16. Department of Health (2009), 'Patient-Level Information and Costing Systems (PLICS)', http://www.dh.gov.uk/en/Managingyourorganisation/ Financeandplanning/NHScostingmanual/DH-080056 [24 August 2010].
17. Department of Health (2010), 'Payment by Results Guidance for 2010-11', http://www.dh.gov.uk/prod-consum-dh/groups/dh-digitalassets/@dh/@en/@ps/ documents/digitalasset/dh-112970.pdf [17 February 2011].
18. Department of Health (2011), 'Payment by Results Guidance for 2011-12', http://www.dh.gov.uk/prod-consum-dh/groups/dh-digitalassets/documents/ digitalasset/dh- 124522.pdf [28 February 2011].
19. Ellis, R. P. (1998), 'Creaming, skimping and dumping: provider competition on the intensive and extensive margins', Journal of Health Economics, 17(5): 537-555. (Pubitemid 28432606)
20. Ellis, R. P. and M. Vidal-Fernández (2007), 'Activity-based payments and reforms of the English hospital payment system', Health Economics, Policy and Law, 2(4): 435-444.
21. Epstein, D. and A. Mason (2006), 'Costs and prices for inpatient care in England: mirror twins or distant cousins'?, Health Care Management Science, 9(3): 233-242. (Pubitemid 44198208)
22. Ettelt, S. and E. Nolte (2010), 'Funding intensive care - approaches in systems using diagnosisrelated groups', http://www.rand.org/pubs/technical- reports/2010/RAND-TR792.pdf [17 June 2010].
23. Ettelt, S., S. Thomson, E. Nolte and N. Mays (2006), Reimbursing Highly Specialised Hospital Services: The Experience of Activity-Based Funding in Eight Countries, London: London School of Hygiene and Tropical Medicine
24. Farrar, S., J. Sussex, D. Yi, M. Sutton, M. Chalkley, T. Scott and A. Ma (2007), National Evaluation of Payment by Results, Aberdeen: Health Economics Research Unit, University of Aberdeen.
25. Farrar, S., D. Yi, M. Sutton, M. Chalkley, J. Sussex and A. Scott (2009), 'Has payment by results affected the way that English hospitals provide care? Difference-in-differences analysis', British Medical Journal, 339: b3047doi:10.1136/bmj.b3047.
26. Friesner, D. L. and R. Rosenman (2004), 'Inpatient-outpatient cost shifting in Washington hospitals', Health Care Management Science, 7(1): 17-26. (Pubitemid 39024061)
27. Geissler, A., D. Scheller-Kreinsen and R. Busse (2011), 'Germany: Understanding G-DRGs', in R. Busse, A. Geissler, W. Quentin and M. Wiley (eds), Diagnosis Related Groups in Europe. Moving Towards Transparency, Efficiency and Quality in Hospitals, Maidenhead: Open University Press.
28. Goldfield, N. (2010), 'The evolution of diagnosis-related groups (DRGs): from its beginnings in case-mix and resource use theory, to its implementation for payment and now for its current utilization for quality within and outside the hospital', Quality Management in Health Care, 19(1): 3-16.
29. Gre', S., A. Focke, F. Hessel and J. Wasem (2006), 'Financial incentives for disease management programmes and integrated care in German social health insurance', Health Policy, 78(2-3): 295-305. (Pubitemid 44247218)
30. Häkkinen, U. (2005), 'The impact of changes in Finland's health care system', Health Economics, 14(Supplement 1): S101-S118. (Pubitemid 41404320)
31. Häkkinen, U. (2010), 'Financing of hospital care in Finland', Euro Observer, 12(3): 10-12.
32. Häkkinen, U. and M. Linna (2005), 'DRGs in Finnish health care', Euro Observer, 7(4): 7-8.
33. Health Service Executive (2008), 'Consultant Contract 2008 - measurement of public:private mix', http://www.hse.ie/eng/staff/HR/tandc/Consultant- Contract-2008--Measurement- of-Public-Private-Mix.pdf [4 August 2010].
34. Health Service Executive (2010a), 'Casemix Budget Outturns for 2009', http://www.hse.ie/eng/services/Publications/corporate/2009casemix.html [12 May 2010].
35. Health Service Executive (2010b), 'HealthStat - Supporting High Performance', http://www.hse.ie/eng/staff/Healthstat/about/[4 August 2010].
36. Health Service Executive (2010c), HSE National Service Plan 2010, Dublin: Health Service Executive.
37. Health Service Executive (2010d), National Service Plan 2011, Dublin: Health Service Executive.
38. Henschke, C., M. Bäumler, S. Weid, M. Gaskins and R. Busse (2010), 'Extrabudgetary (''NUB'') payments: a gateway for introducing new medical devices into the German inpatient reimbursement system'? Journal of Management & Marketing in Healthcare, 3(2): 119-133.
39. Hensen, P., S. Beissert, L. Bruckner-Tuderman, T. A. Luger, N. Roeder and M. L. Muller (2008), 'Introduction of diagnosis-related groups in Germany: evaluation of impact on in-patient care in a dermatological setting', European Journal of Public Health, 18(1): 85-91. (Pubitemid 351161366)
40. Jegers, M., K. Kesteloot, D. De Graeve and W. Gilles (2002), 'A typology for provider payment systems in health care', Health Policy, 60(3): 255-273. (Pubitemid 34326469)
41. Kahn, K. L., L. V. Rubenstein, D. Draper, J. Kosecoff, W. H. Rogers, E. B. Keeler and R. H. Brook (1990), 'The effects of the DRG-based prospective payment system on quality of care for hospitalized Medicare patients: an introduction to the series', Journal of the American Medical Association, 264(15): 1953-1955. (Pubitemid 20349419)
42. Kautianen, K., U. Häkkinen and J. Lauharanta (2011), 'Finland: DRGs in a Decentralized Health Care System', in R. Busse, A. Geissler, W. Quentin and M. Wiley (eds), Diagnosis Related Groups in Europe. Moving Towards Transparency, Efficiency and Quality in Hospitals, Maidenhead: Open University Press. Paying for hospital care in five European countries 97
43. Kimberly, J. R. and G. de Pouvourville and Associates (1993), The Migration of Managerial Innovation: Diagnosis-Related Groups and Health Care Administration in Western Europe, San Francisco: Jossey-Bass Inc.
44. Kimberly, J. R., G. de Pouvourville and T. D'Aunno (2008), The Globalization of Managerial Innovation in Health Care, Cambridge: Cambridge University Press.
45. Kittelsen, S. A. C., K. S. Anthun, B. Kalseth, J. Kalseth, V. Halsteinli and J. Magnussen (2009), 'En komparativ analyse av spesialisthelsetjenesten i Finland, Sverige, Danmark og Norge: Aktivitet, ressursbruk og produktivitet 2005-2007', http://www.sintef.no/upload/Helse/%C3%98KT/Pdf-filer/SINTEF-Rapport- A12200-Analyse- speshelsetjenesten-Finland-Sverige-Danmark-Norge.pdf [2 March 2011].
46. Kobel, C., J. Thuilliez, M. Bellanger and K.-P. Pfeiffer (2011), 'DRG Systems and Similar Patient Classification Systems in Europe', in R. Busse, A. Geissler, W. Quentin and M. Wiley (eds), Diagnosis Related Groups in Europe. Moving Towards Transparency, Efficiency and Quality in Hospitals, Maidenhead: Open University Press.
47. Kosecoff, J., K. L. Kahn, W. H. Rogers, E. J. Reinisch, M. J. Sherwood, L. V. Rubenstein, D. Draper, C. P. Roth, C. Chew and R. H. Brook (1990), 'Prospective payment system and impairment at discharge: the ''quicker-and-sicker'' story revisited', Journal of the American Medical Association, 264(15): 1980-1983. (Pubitemid 20349424)
48. Kutzin, J. (2001), 'A descriptive framework for country-level analysis of health care financing arrangements', Health Policy, 56(3): 171-204. (Pubitemid 32496518)
49. Langenbrunner, J., E. Orosz, J. Kutzin and M. M. Wiley (2005), 'Purchasing and Paying Providers', in J. Figueras, R. Robinson and E. Jakubowski (eds), Purchasing to Improve Health Systems Performance, Maidenhead: Open University Press.
50. Langenbrunner, J. C. and M. M. Wiley (2002), 'Hospital Payment Mechanisms: Theory and Practice in Transition Countries', in M. McKee and J. Healy (eds), Hospitals in a Changing Europe, Buckingham: Open University Press.
51. Leister, J. E. and J. Stausberg (2005), 'Comparison of cost accounting methods from different DRG systems and their effect on health care quality', Health Policy, 74(1): 46-55. (Pubitemid 41132571)
52. Linna, M. and U. Häkkinen (2008), 'Benchmarking Finnish Hospitals', in J. Blank and V. Valdmanis (eds), Evaluating Hospital Policy and Performance: Contributions from Hospital Policy and Productivity Research, Oxford: JAI Press.
53. Linna, M., U. Häkkinen and J. Magnussen (2006), 'Comparing hospital cost efficiency between Norway and Finland', Health Policy, 77(3): 268-278. (Pubitemid 43946518)
54. Linna, M., U. Häkkinen, M. Peltola, J. Magnussen, K. Anthun, S. Kittelsen, A. Roed, K. Olsen, E. Medin and C. Rehnberg (2010), 'Measuring cost efficiency in the Nordic Hospitals - a cross-sectional comparison of public hospitals in 2002', Health Care Management Science, 13(4): 346-357.
55. Lungen, M., B. Dredge, A. Rose, C. Roebuck, E. Plamper, K. Lauterbach and The Working Group (2004) 'Using diagnosis-related groups: the situation in the United Kingdom National Health Service and in Germany', European Journal of Health Economics, 5(4): 287-289. (Pubitemid 40543179)
56. Lungen, M. and I. Lapsley (2003), 'The reform of hospital financing in Germany: an international solution'?, Journal of Health Organization and Management, 17(5): 360-372.
57. Mannion, R., G. Marini and A. Street (2008), 'Implementing payment by results in the English NHS: changing incentives and the role of information', Journal of Health Organization and Management, 22(1): 79-88.
58. Mannion, R. and A. Street (2005), Payment by Results and Demand Management: Learning from the South Yorkshire laboratory. CHE Research Paper 14, York: University of York
59. Mason, A. and M. Goddard (2009), Payment by Results in Mental Health: A Review of the International Literature and an Economic Assessment of the Approach in the English NHS. CHE Research Paper 50, York: University of York.
60. Mason, A., A. Street, M. Miraldo and L. Siciliani (2009), 'Should prospective payments be differentiated for public and private healthcare providers'?, Health Economics, Policy and Law, 4(Pt 4): 383-403.
61. Mason, A., P. Ward and A. Street (2011), 'England: The Healthcare Resource Group System', in R. Busse, A. Geissler, W. Quentin and M. Wiley (eds), Diagnosis Related Groups in Europe. Moving Towards Transparency, Efficiency and Quality in Hospitals, Maidenhead: Open University Press.
62. McDaid, D., M. Wiley, A. Maresso and E. Mossialos (2009), 'Ireland: health system review', Health Systems in Transition, 11(4): 1-268.
63. McNair, P., H. Luft and A. Bindman (2009), 'Medicare's policy not to pay for treating hospital-acquired conditions: the impact', Health Affairs, 28(5): 1485-1493.
64. Michelot, X. and J.-M. Rodrigues (2008), 'DRGs in France', in J. Kimberly, G. de Pouvourville and T. D'Aunno (eds), The Globalization of Managerial Innovation in Health Care, Cambridge: Cambridge University Press.
65. Mikkola, H. (2003), 'Hospital pricing reform in the public health care system-an empirical case study from Finland', International Journal of Health Care Finance and Economics, 3(4): 267-286.
66. Mikkola, H. and U. Häkkinen (2002), 'The effects of case-based pricing on length of stay for common surgical procedures', Journal of Health Services Research and Policy, 7(2): 90-97. (Pubitemid 34984014)
67. Ministry of Health (2009), 'Rapport 2009 au Parlement sur la tarificationa l'activite´ (T2A)', http://www.sante.gouv.fr/IMG/pdf/ Rapport-T2A-2009.pdf [1 March 2011].
68. Ministry of Health (2010), 'Rapport 2010 au Parlement sur la tarificationa l'activite´ (T2A)', http://www.sante.gouv.fr/IMG/pdf/ Rapport-T2A-2010.pdf [1 March 2011].
69. Miraldo, M., M. Goddard and P. C. Smith (2006), The Incentive Effects of Payment by Results. CHE Research Paper 19, London: Dr Foster Intelligence.
70. Moreno-Serra, R. and A. Wagstaff (2010), 'System-wide impacts of hospital payment reforms: evidence from Central and Eastern Europe and Central Asia', Journal of Health Economics, 29(4): 585-602.
71. Newhouse, J. P. (1996), 'Reimbursing health plans and health providers: efficiency in production versus selection', Journal of Economic Literature, 34(3): 1236-1263. (Pubitemid 126420568)
72. NHS Information Centre (2010), 'Healthcare Resource Groups 4 (HRG4)', www.ic.nhs.uk/services/the-casemix-service/new-to-this-service/ healthcare-resource-groups-4-hrg4 [17 June 2010].
73. O'Reilly, J., B. McCarthy and M. Wiley (2011), 'Ireland: A Review of Casemix Applications Within the Acute Public Hospital System', in R. Busse, A. Geissler, W. Quentin and M. Wiley (eds), Diagnosis Related Groups in Europe. Moving Towards Transparency, Efficiency and Quality in Hospitals, Maidenhead: Open University Press.
74. Oliver, A. (2005), 'The English National Health Service: 1979-2005', Health Economics, 14(Supplement 1): S75-S99. (Pubitemid 41404319)
75. Or, Z. (2009), 'Activity based payment in France', Euro Observer, 11(4): 5-6.
76. Or, Z. and M. Bellanger (2011), 'France: Implementing Homogeneous Patient Groups in a Mixed Market', in R. Busse, A. Geissler, W. Quentin and M. Wiley (eds), Diagnosis Related Groups in Europe. Moving Towards Transparency, Efficiency and Quality in Hospitals, Maidenhead: Open University Press.
77. Or, Z. and U. Häkkinen (2011), 'DRGs and Quality: For Better or Worse'?, in R. Busse, A. Geissler, W. Quentin and M. Wiley (eds), Diagnosis Related Groups in Europe. Moving Towards Transparency, Efficiency and Quality in Hospitals, Maidenhead: Open University Press.
78. Pronovost, P. J., C. A. Goeschel and R. M. Wachter (2008), 'The wisdom and justice of not paying for ''preventable complications'' ', Journal of the American Medical Association, 299(18): 2197-2199. (Pubitemid 351679711)
79. Propper, C., M. Sutton, C. Whitnall and F.Windmeijer (2007), Did 'targets and terror' reduce English waiting times for elective hospital care?, CMPO Working Paper no. 07/179
80. Rosenberg, M. A. and M. J. Browne (2001), 'The impact of the inpatient prospective payment system and diagnosis-related groups: a survey of the literature', North American Actuarial Journal, 5(4): 84-94.
81. Scheller-Kreinsen, D., A. Geissler and R. Busse (2009), 'The ABC of DRGs', Euro Observer, 11(4): 1-5.
82. Schreyö gg, J., T. Stargardt, O. Tiemann and R. Busse (2006a), 'Methods to determine reimbursement rates for diagnosis related groups (DRG): a comparison of nine European countries', Health Care Management Science, 9(3): 215-223. (Pubitemid 44198206)
83. Schreyö gg, J., O. Tiemann and R. Busse (2005), 'The DRG reimbursement system in Germany', Euro Observer, 7(4): 4-6.
84. Schreyö gg, J., O. Tiemann and R. Busse (2006b), 'Cost accounting to determine prices: how well do prices reflect costs in the German DRG-system'?, Health Care Management Science, 9(3): 269-279. (Pubitemid 44198212)
85. Shleifer, A. (1985), 'A theory of yardstick competition', RAND Journal of Economics, 16(3): 319-327.
86. Smith, P. C. and A. Street (2005), 'Measuring the efficiency of public services: the limits of analysis', Journal of the Royal Statistical Society. Series A (Statistics in Society), 168(2): 401-417. (Pubitemid 40427717)
87. Steinbusch, P. J., J. B. Oostenbrink, J. J. Zuurbier and F. J. Schaepkens (2007), 'The risk of upcoding in casemix systems: a comparative study', Health Policy, 81(2-3): 289-299. (Pubitemid 46437415)
88. Street, A. (2006), 'Reform of Hospital Funding and the Introduction of Patient Choice in England', http://www.york.ac.uk/inst/che/pdf/REES%205- 2%20English.pdf [24 August 2010].
89. Street, A. and A. Maynard (2007), 'Activity based financing in England: the need for continual refinement of payment by results', Health Economics, Policy and Law, 2(4): 419-427.
90. Street, A. and M. Miraldo (2007), 'The impact of the reform of hospital funding in England', Paper presented at Evaluating Health Policy: New Evidence from Administrative Data, University of York, http://www.york.ac.uk/media/che/ documents/papers/che-2007- impactreform.pdf [15 August 2011].
91. Street, A., J. O'Reilly, P. Ward and A. Mason (2011), 'DRG-Based Hospital Payment and Efficiency: Theory, Evidence, and Challenges', in R. Busse, A. Geissler, W. Quentin and M. Wiley (eds), Diagnosis Related Groups in Europe. Moving Towards Transparency, Efficiency and Quality in Hospitals, Maidenhead: Open University Press.
92. Street, A., D. Scheller-Kreinsen, A. Geissler and R. Busse (2010), Determinants of hospital costs and performance variation: methods, models and variables for the EuroDRG Project, Working Papers in Health Policy and Management Volume 3, Berlin: Berlin University of Technology.
93. Street, A., K. Vitikainen, A. Bjorvatn and A. Hvenegaard (2007), Introducing activity-based financing: a review of experience in Australia, Denmark, Norway and Sweden, CHE Research Paper 30, York: University of York.
94. Sussex, J. and S. Farrar (2009), 'Activity-based funding for National Health Service hospitals in England: managers' experience and expectations', European Journal of Health Economics, 10(2): 197-206.
95. Tan, S. S., L. Serde´n, A. Geissler,M. Van Ineveld, K. Redekop, M. Heurgren and L. Hakkaart-Van Roijen (2011), 'DRGs and Cost Accounting: Which is Driving Which'?, in R. Busse, A.Geissler, W. Quentin andM. Wiley (eds), Diagnosis Related Groups in Europe. Moving Towards Transparency, Efficiency and Quality in Hospitals,Maidenhead: Open University Press.
96. US Congress Office of Technology Assessment (1985), Medicare's Prospective Payment System: Strategies for Evaluating Cost, Quality, and Medical Technology, Washington, DC: US Government Printing Office.
97. Vuorenkoski, L., P. Mladovsky and E. Mossialos (2008), 'Finland: health system review', Health Systems in Transition, 10(4): 1-168.
98. Wiley, M. (2005a), 'Diagnosis Related Groups (DRGs): Measuring Hospital Case Mix', in P. Armitage and T. Colton (eds), Encyclopedia of Biostatistics, Chichester: John Wiley & Sons, Ltd.
99. Wiley M.M. 2005 The irish health system: Developments in strategy structure funding and delivery since 1980 Health Economics 14 1 S169-S186 (Pubitemid 41404323)