IDEAS home Printed from https://ideas.repec.org/a/kap/ijhcfe/v20y2020i1d10.1007_s10754-019-09267-w.html
   My bibliography  Save this article

The impact of hospital-acquired infections on the patient-level reimbursement-cost relationship in a DRG-based hospital payment system

Author

Listed:
  • Klaus Kaier

    (Faculty of Medicine and Medical Center – University of Freiburg)

  • Martin Wolkewitz

    (Faculty of Medicine and Medical Center – University of Freiburg)

  • Philip Hehn

    (Faculty of Medicine and Medical Center – University of Freiburg)

  • Nico T. Mutters

    (Medical Center – University of Freiburg)

  • Thomas Heister

    (Faculty of Medicine and Medical Center – University of Freiburg)

Abstract

Hospital-acquired infections (HAIs) are a common complication in inpatient care. We investigate the incentives to prevent HAIs under the German DRG-based reimbursement system. We analyze the relationship between resource use and reimbursements for HAI in 188,731 patient records from the University Medical Center Freiburg (2011–2014), comparing cases to appropriate non-HAI controls. Resource use is approximated using national standardized costing system data. Reimbursements are the actual payments to hospitals under the G-DRG system. Timing of HAI exposure, cost-clustering within main diagnoses and risk-adjustment are considered. The reimbursement-cost difference of HAI patients is negative (approximately − €4000). While controls on average also have a negative reimbursement-cost difference (approximately − €2000), HAI significantly increase this difference after controlling for confounding and timing of infection (− 1500, p

Suggested Citation

  • Klaus Kaier & Martin Wolkewitz & Philip Hehn & Nico T. Mutters & Thomas Heister, 2020. "The impact of hospital-acquired infections on the patient-level reimbursement-cost relationship in a DRG-based hospital payment system," International Journal of Health Economics and Management, Springer, vol. 20(1), pages 1-11, March.
    • Handle: RePEc:kap:ijhcfe:v:20:y:2020:i:1:d:10.1007_s10754-019-09267-w
    DOI: 10.1007/s10754-019-09267-w
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s10754-019-09267-w
    File Function: Abstract
    Download Restriction: Access to full text is restricted to subscribers.
    File URL: https://libkey.io/10.1007/s10754-019-09267-w?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Søren Rud Kristensen, 2017. "Financial Penalties for Performance in Health Care," Health Economics, John Wiley & Sons, Ltd., vol. 26(2), pages 143-148, February.
    2. Matthias Vogl, 2012. "Assessing DRG cost accounting with respect to resource allocation and tariff calculation: the case of Germany," Health Economics Review, Springer, vol. 2(1), pages 1-12, December.
    3. Ansgar Resch & Michael Wilke & Christian Fink, 2009. "The cost of resistance: incremental cost of methicillin-resistant Staphylococcus aureus (MRSA) in German hospitals," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 10(3), pages 287-297, July.
    4. Thomas Heister & Christian Hagist & Klaus Kaier, 2017. "Resistance Elasticity of Antibiotic Demand in Intensive Care," Health Economics, John Wiley & Sons, Ltd., vol. 26(7), pages 892-909, July.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Rieka von der Warth & Philip Hehn & Jan Wolff & Klaus Kaier, 2020. "Hospital costs associated with post-traumatic stress disorder in somatic patients: a retrospective study," Health Economics Review, Springer, vol. 10(1), pages 1-8, December.
    2. repec:mea:meawpa:13272 is not listed on IDEAS
    3. Giuseppe Moscelli & Hugh Gravelle & Luigi Siciliani, 2018. "Effects of Market Structure and Patient Choice on Hospital Quality for Planned Patients," School of Economics Discussion Papers 1118, School of Economics, University of Surrey.
    4. Klaus Kaier & Holger Reinecke & Huseyin Naci & Lutz Frankenstein & Martin Bode & Werner Vach & Philip Hehn & Andreas Zirlik & Manfred Zehender & Jochen Reinöhl, 2018. "The impact of post-procedural complications on reimbursement, length of stay and mechanical ventilation among patients undergoing transcatheter aortic valve implantation in Germany," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(2), pages 223-228, March.
    5. Vogl, Matthias, 2014. "Hospital financing: Calculating inpatient capital costs in Germany with a comparative view on operating costs and the English costing scheme," Health Policy, Elsevier, vol. 115(2), pages 141-151.
    6. Jürges, Hendrik & Köberlein, Juliane, 2015. "What explains DRG upcoding in neonatology? The roles of financial incentives and infant health," Journal of Health Economics, Elsevier, vol. 43(C), pages 13-26.
    7. Klaus Kaier & Constantin Mühlen & Andreas Zirlik & Wolfgang Bothe & Philip Hehn & Manfred Zehender & Christoph Bode & Peter Stachon, 2019. "Estimating the additional costs per life saved due to transcatheter aortic valve replacement: a secondary data analysis of electronic health records in Germany," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(4), pages 625-632, June.
    8. Christoph Baltin & Florian Kron & Alexander Urbanski & Thomas Zander & Anna Kron & Felix Berlth & Robert Kleinert & Michael Hallek & Arnulf Heinrich Hoelscher & Seung-Hun Chon, 2019. "The economic burden of endoscopic treatment for anastomotic leaks following oncological Ivor Lewis esophagectomy," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-12, August.
    9. Miquel Serra-Burriel & Matthew Keys & Carlos Campillo-Artero & Antonella Agodi & Martina Barchitta & Achilleas Gikas & Carlos Palos & Guillem López-Casasnovas, 2020. "Impact of multi-drug resistant bacteria on economic and clinical outcomes of healthcare-associated infections in adults: Systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-14, January.
    10. Feng, Yan & Kristensen, Søren Rud & Lorgelly, Paula & Meacock, Rachel & Sanchez, Marina Rodes & Siciliani, Luigi & Sutton, Matt, 2019. "Pay for performance for specialised care in England: Strengths and weaknesses," Health Policy, Elsevier, vol. 123(11), pages 1036-1041.
    11. Henri Teittinen & Janina Männikkö, 2022. "Case-Mix Accounting System Design in Social and Health Care Sector - The Mechanisms of Hybridization," European Financial and Accounting Journal, Prague University of Economics and Business, vol. 2022(3), pages 49-69.
    12. Roland Diel & Albert Nienhaus, 2019. "Cost–Benefit Analysis of Real-Time Influenza Testing for Patients in German Emergency Rooms," IJERPH, MDPI, vol. 16(13), pages 1-16, July.
    13. Roland Diel & Albert Nienhaus, 2023. "Cost–Benefit of Real-Time Multiplex PCR Testing of SARS-CoV-2 in German Hospitals," IJERPH, MDPI, vol. 20(4), pages 1-12, February.
    14. Hendrik Jürges & Juliane Köberlein, 2013. "First Do No Harm. Then Do Not Cheat: DRG Upcoding in German Neonatology," Discussion Papers of DIW Berlin 1314, DIW Berlin, German Institute for Economic Research.
    15. Isabel C. P. Marques & Maria-Ceu Alves, 2023. "Hospital Costing Methods: Four Decades of Literature Review," JRFM, MDPI, vol. 16(10), pages 1-22, October.
    16. Giuseppe Moscelli & Hugh Gravelle & Luigi Siciliani, 2021. "Hospital competition and quality for non‐emergency patients in the English NHS," RAND Journal of Economics, RAND Corporation, vol. 52(2), pages 382-414, June.
    17. Dubois, Pierre & Gokkoca, Gokce, 2023. "Antibiotic Demand in the Presence of Antimicrobial Resistance," TSE Working Papers 23-1457, Toulouse School of Economics (TSE).
    18. Irma Convertino & Stefano Salvadori & Alessandro Pecori & Maria Teresa Galiulo & Sara Ferraro & Maria Parrilli & Tiberio Corona & Giuseppe Turchetti & Corrado Blandizzi & Marco Tuccori, 2019. "Potential Direct Costs of Adverse Drug Events and Possible Cost Savings Achievable by their Prevention in Tuscany, Italy: A Model-Based Analysis," Drug Safety, Springer, vol. 42(3), pages 427-444, March.
    19. Xidong Guo, 2024. "An analysis of a rural hospital's investment decision under different payment systems," Health Economics, John Wiley & Sons, Ltd., vol. 33(4), pages 714-747, April.
    20. Malgorzata Cyganska & Piotr Cyganski & Chris Pyke, 2019. "Development of clinical value unit method for calculating patient costs," Health Economics, John Wiley & Sons, Ltd., vol. 28(8), pages 971-983, August.
    21. Klaus Kaier & S. Moog, 2012. "Economic Consequences of the Demography of MRSA Patients and the Impact of Broad-Spectrum Antimicrobials," Applied Health Economics and Health Policy, Springer, vol. 10(4), pages 227-234, July.

    More about this item

    Keywords

    HAI; G-DRG; Incentives; Reimbursement; Cost;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:kap:ijhcfe:v:20:y:2020:i:1:d:10.1007_s10754-019-09267-w. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.