Modelling the effects of the Austrian inpatient reimbursement system on length-of-stay distributions

Abstract. This paper analyses the effects of the new Austrian performance-oriented inpatient payment system on discharge strategies of hospitals by investigating length-of-stay (LOS) distributions. Using generalised linear models applied to data from 1998, we calculate the impact of day and month of admission as well as types of admission and discharge on the LOS of inpatients with major diagnoses. Hereby, we prove significant interdependencies among these variables and reveal hospital behaviour such as 1) premature discharges of inpatients or “unbundling” and 2) “patient splitting”. Hence, our findings illustrate that hospitals react to incentives set by the new system in order to maximise their revenues. Hence, the current reimbursement system still has potential for cost reduction while maintaining high quality of health care. Our strategic policy model supports decision makers in disclosing these effects and provides policy implications to close exploitable gaps within the new reimbursement system.

[1]  Paul J. Feldstein,et al.  Health care economics , 1979 .

[2]  P. McCullagh,et al.  Generalized Linear Models , 1992 .

[3]  J. Lave,et al.  A comparison of hospital responses to reimbursement policies for Medicaid psychiatric patients. , 1989, The Rand journal of economics.

[4]  J. Kronenfeld,et al.  Regulation, retrenchment--the DRG experience: problems from changing reimbursement practice. , 1990, Social science & medicine.

[5]  Robert B. Fetter,et al.  Diagnosis Related Groups: Understanding Hospital Performance , 1991 .

[6]  A. Son.  Modernisation of the system of traditional Korean medicine (1876-1990). , 1998, Health policy.

[7]  A Marazzi,et al.  Fitting the distributions of length of stay by parametric models. , 1998, Medical care.

[8]  U. Ruttimann,et al.  Length of stay and efficiency in pediatric intensive care units. , 1998, The Journal of pediatrics.

[9]  J. Figueras,et al.  Analyzing the evidence on European health care reforms. , 1998, Health affairs.

[10]  F. Stoss.  [Experiences with the pilot project in achievement-oriented hospital financing in Vorarlberg]. , 1999, Wiener klinische Wochenschrift.

[11]  C. Laine,et al.  Impact of a DRG-based hospital financing system on quality and outcomes of care in Italy. , 1999, Health services research.

[12]  G. Anderson,et al.  Health spending, access, and outcomes: trends in industrialized countries. , 1999, Health affairs.

[13]  M. Sommersguter-Reichmann,et al.  Priority setting in Austria. , 1999, Health policy.

[14]  Marion S. Rauner,et al.  EVALUATION OF THE NEW AUSTRIAN INPATIENT REIMBURSEMENT SYSTEM , 1999 .

[15]  M. Sommersguter-Reichmann.  The impact of the Austrian hospital financing reform on hospital productivity: empirical evidence on efficiency and technology changes using a non-parametric input-based Malmquist approach , 2000, Health care management science.

[16]  S. Guterman,et al.  An analysis of hospital productivity and product change. , 2000, Health affairs.

[17]  Evaluating the New Activity-Based Hospital Financing System in Austria , 2000 .

[18]  P. Romano,et al.  Risk-adjusting acute myocardial infarction mortality: are APR-DRGs the right tool? , 2000, Health services research.

[19]  R. Lowes.  Hospital-stay guidelines: just plain weird. , 2001, Medical economics.

[20]  Marion S. Rauner,et al.  Interplay between in-patient reimbursement systems and healthcare technology management: the Austrian case , 2001 .

[21]  H Lippman.  The bottom line on length of stay. , 2001, Business and health.

[22]  U. Frick,et al.  Auswirkungen der leistungsorientierten Krankenhausfinanzierung (LKF) auf die Verweildauern und Hospitalisierungen im Land Salzburg seit 1997 , 2001 .

[23]  U. Frick,et al.  Fallpauschalen in der stationär-psychiatrischen Versorgung , 2001 .

[24]  J M Eisenberg.  Putting research to work: reporting and enhancing the impact of health services research. , 2001, Health services research.

[25]  Marion S. Rauner,et al.  Impact of the new Austrian inpatient payment strategy on hospital behavior: a system-dynamics model , 2002 .