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Effects of DRG-based hospital payment in Poland on treatment of patients with stroke

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  • Bystrov, Victor
  • Staszewska-Bystrova, Anna
  • Rutkowski, Daniel
  • Hermanowski, Tomasz

Abstract

A prospective payment system based on Diagnosis Related Groups (DRGs) presents strong financial incentives to healthcare providers. These incentives may have intended as well as unintended consequences for the healthcare system. In this paper we use administrative data on stroke admissions to Polish hospitals in order to demonstrate the response of hospitals to the incentives embedded in the design of stroke-related groups in Poland. The design was intended to motivate hospitals for the development of specialized stroke units by paying significantly higher tariffs for treatment of patients in these units. As a result, an extensive network of stroke units has emerged. However, as it is shown in the paper, there is no evidence that outcomes in hospitals with stroke units are significantly different from outcomes in hospitals without stroke units. It is also demonstrated that the reliance on the length of stay as a major grouping variable provides incentives for regrouping patients into more expensive groups by extending their length of stay in stroke units. The results of the study are limited by the incompleteness of the casemix data. There is a need to develop information and audit systems which would further inform a revision of the DRG system aimed to reduce the risk of regrouping and up-coding.

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  • Bystrov, Victor & Staszewska-Bystrova, Anna & Rutkowski, Daniel & Hermanowski, Tomasz, 2015. "Effects of DRG-based hospital payment in Poland on treatment of patients with stroke," Health Policy, Elsevier, vol. 119(8), pages 1119-1125.
    • Handle: RePEc:eee:hepoli:v:119:y:2015:i:8:p:1119-1125
    DOI: 10.1016/j.healthpol.2015.04.017
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    1. David Epstein & Anne Mason & Andrea Manca, 2008. "The hospital costs of care for stroke in nine European countries," Health Economics, John Wiley & Sons, Ltd., vol. 17(S1), pages 21-31, January.
    2. Adam Kozierkiewicz & Maciej Stamirski & Waldemar Stylo & Wojciech Trąbka, 2006. "The definition of prices for inpatient care in Poland in the absence of cost data," Health Care Management Science, Springer, vol. 9(3), pages 281-286, August.
    3. Reinhard Busse & Alexander Geissler & Anne Mason & Zeynep Or & David Scheller‐Kreinsen & Andrew Street & Mikko Peltola, 2012. "Patient Classification And Hospital Costs Of Care For Stroke In 10 European Countries," Health Economics, John Wiley & Sons, Ltd., vol. 21, pages 129-140, August.
    4. Ellis, Randall P., 1998. "Creaming, skimping and dumping: provider competition on the intensive and extensive margins1," Journal of Health Economics, Elsevier, vol. 17(5), pages 537-555, October.
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    1. Melberg, Hans Olav & Beck Olsen, Camilla & Pedersen, Kine, 2016. "Did hospitals respond to changes in weights of Diagnosis Related Groups in Norway between 2006 and 2013?," Health Policy, Elsevier, vol. 120(9), pages 992-1000.
    2. Buczak-Stec, Elżbieta & Goryński, Paweł & Nitsch-Osuch, Aneta & Kanecki, Krzysztof & Tyszko, Piotr, 2017. "The impact of introducing a new hospital financing system (DRGs) in Poland on hospitalisations for atherosclerosis: An interrupted time series analysis (2004–2012)," Health Policy, Elsevier, vol. 121(11), pages 1186-1193.
    3. Dai Su & Yingchun Chen & Hongxia Gao & Haomiao Li & Jingjing Chang & Shihan Lei & Di Jiang & Xiaomei Hu & Min Tan & Zhifang Chen, 2019. "Is There a Difference in the Utilisation of Inpatient Services Between Two Typical Payment Methods of Health Insurance? Evidence from the New Rural Cooperative Medical Scheme in China," IJERPH, MDPI, vol. 16(8), pages 1-16, April.

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