IDEAS home Printed from https://ideas.repec.org/a/sae/padigm/v18y2014i2p121-134.html
   My bibliography  Save this article

Ambulatory Patient Groups

Author

Listed:
  • Monika Raulinajtys-Grzybek

Abstract

This article examines what potential effects the implementation of the payment system per “patient case†might have on the health service structure and providers’ behaviour. Author analyzed the case of the pricing system of ambulatory services that was implemented in Poland in 2011. This system is based on the concept of ambulatory patient groups—the modification of diagnosis-related groups dedicated to the ambulatory health care. Improper design of grouping and pricing services—in particular, the lack of cost homogeneity and different level of profitability of different groups—may result in undesirable behaviours of providers, including, in particular, unjustified increasing or decreasing the number of services. The study shows that in recent years such undesirable phenomena occurred in Poland. In the case of most of the analyzed groups, the change in the price level resulted in the reaction of the providers that was significantly different from their behaviour in relation to other groups and/or behaviour in relation to tested variables in the period before the change in pricing.

Suggested Citation

  • Monika Raulinajtys-Grzybek, 2014. "Ambulatory Patient Groups," Paradigm, , vol. 18(2), pages 121-134, December.
    • Handle: RePEc:sae:padigm:v:18:y:2014:i:2:p:121-134
    DOI: 10.1177/0971890714558682
    as

    Download full text from publisher

    File URL: https://journals.sagepub.com/doi/10.1177/0971890714558682
    Download Restriction: no
    File URL: https://libkey.io/10.1177/0971890714558682?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
    ---><---

    References listed on IDEAS

    as
    1. Kirsi Vitikainen & Miika Linna & Andrew Street, 2010. "Substituting inpatient for outpatient care: what is the impact on hospital costs and efficiency?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(4), pages 395-404, August.
    2. Vitikainen, Kirsi & Street, Andrew & Linna, Miika, 2009. "Estimation of hospital efficiency--Do different definitions and casemix measures for hospital output affect the results?," Health Policy, Elsevier, vol. 89(2), pages 149-159, February.
    3. Evers, Silvia & Voss, Gemma & Nieman, Fred & Ament, Andre & Groot, Tom & Lodder, Jan & Boreas, Anita & Blaauw, Gerhard, 2002. "Predicting the cost of hospital stay for stroke patients: the use of diagnosis related groups," Health Policy, Elsevier, vol. 61(1), pages 21-42, July.
    4. Anni Ankjær-Jensen & Pernille Rosling & Lone Bilde, 2006. "Variable prospective financing in the Danish hospital sector and the development of a Danish case-mix system," Health Care Management Science, Springer, vol. 9(3), pages 259-268, August.
    5. Jegers, Marc & Kesteloot, Katrien & De Graeve, Diana & Gilles, Willem, 2002. "A typology for provider payment systems in health care," Health Policy, Elsevier, vol. 60(3), pages 255-273, June.
    6. Leister, Jan Eric & Stausberg, Jurgen, 2005. "Comparison of cost accounting methods from different DRG systems and their effect on health care quality," Health Policy, Elsevier, vol. 74(1), pages 46-55, September.
    7. Stefan Felder, 2009. "The variance of length of stay and the optimal DRG outlier payments," International Journal of Health Economics and Management, Springer, vol. 9(3), pages 279-289, September.
    8. Waters, Hugh R. & Hussey, Peter, 2004. "Pricing health services for purchasers--a review of methods and experiences," Health Policy, Elsevier, vol. 70(2), pages 175-184, November.
    9. He, Daifeng & Mellor, Jennifer M., 2012. "Hospital volume responses to Medicare's Outpatient Prospective Payment System: Evidence from Florida," Journal of Health Economics, Elsevier, vol. 31(5), pages 730-743.
    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. Raulinajtys-Grzybek, Monika, 2014. "Cost accounting models used for price-setting of health services: An international review," Health Policy, Elsevier, vol. 118(3), pages 341-353.
    2. Garcia-Lacalle, Javier & Martin, Emilio, 2010. "Rural vs urban hospital performance in a 'competitive' public health service," Social Science & Medicine, Elsevier, vol. 71(6), pages 1131-1140, September.
    3. Mads Leth Felsager Jakobsen & Thomas Pallesen, 2017. "Performance Budgeting in Practice: the Case of Danish Hospital Management," Public Organization Review, Springer, vol. 17(2), pages 255-273, June.
    4. Lai, Yi & Fu, Hongqiao & Li, Ling & Yip, Winnie, 2022. "Hospital response to a case-based payment scheme under regional global budget: The case of Guangzhou in China," Social Science & Medicine, Elsevier, vol. 292(C).
    5. Margit Sommersguter-Reichmann & Adolf Stepan, 2017. "Hospital physician payment mechanisms in Austria: do they provide gateways to institutional corruption?," Health Economics Review, Springer, vol. 7(1), pages 1-13, December.
    6. Gifford, Rachel & Molleman, Eric & van der Vaart, Taco, 2024. "It's a jungle out there: Understanding physician payment and its role in group dynamics," Social Science & Medicine, Elsevier, vol. 350(C).
    7. Kristensen, Troels & Olsen, Kim Rose & Kilsmark, Jannie & Lauridsen, Jørgen T. & Pedersen, Kjeld Møller, 2012. "Economies of scale and scope in the Danish hospital sector prior to radical restructuring plans," Health Policy, Elsevier, vol. 106(2), pages 120-126.
    8. Fengrong Liu & Jiayu Chen & Chaozhu Li & Fenghui Xu, 2023. "Cost Sharing and Cost Shifting Mechanisms under a per Diem Payment System in a County of China," IJERPH, MDPI, vol. 20(3), pages 1-12, January.
    9. Tummers, L.G. & Van de Walle, Steven, 2012. "Explaining health care professionals’ resistance to implement Diagnosis Related Groups: (No) benefits for society, patients and professionals," Health Policy, Elsevier, vol. 108(2), pages 158-166.
    10. Nolan, Anne, 2019. "Reforming the delivery of public dental services in Ireland: potential cost implications," Research Series, Economic and Social Research Institute (ESRI), number RS80.
    11. Claudia Keser & Claude Montmarquette & Martin Schmidt & Cornelius Schnitzler, 2020. "Custom-made health-care: an experimental investigation," Health Economics Review, Springer, vol. 10(1), pages 1-12, December.
    12. Andersson, Tommy & Ellegård, Lina Maria & Enache, Andreea & Erlanson, Albin & Thami, Prakriti, 2021. "Multiple Pricing for Personal Assistance Services," Working Papers 2021:14, Lund University, Department of Economics, revised 02 May 2024.
    13. Salm, Martin & Wübker, Ansgar, 2018. "Do higher hospital reimbursement prices improve quality of care?," Ruhr Economic Papers 779, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    14. Johannessen, Karl Arne & Kittelsen, Sverre A.C. & Hagen, Terje P., 2017. "Assessing physician productivity following Norwegian hospital reform: A panel and data envelopment analysis," Social Science & Medicine, Elsevier, vol. 175(C), pages 117-126.
    15. Kim Rose Olsen & Andrew Street, 2008. "The analysis of efficiency among a small number of organisations: How inferences can be improved by exploiting patient‐level data," Health Economics, John Wiley & Sons, Ltd., vol. 17(6), pages 671-681, June.
    16. Daifeng He & Peter McHenry & Jennifer M. Mellor, 2020. "Do financial incentives matter? Effects of Medicare price shocks on skilled nursing facility care," Health Economics, John Wiley & Sons, Ltd., vol. 29(6), pages 655-670, June.
    17. Xilong Pan & Hassan H. Dib & Minmin Zhu & Ying Zhang & Yang Fan, 2009. "Absence of appropriate hospitalization cost control for patients with medical insurance: a comparative analysis study," Health Economics, John Wiley & Sons, Ltd., vol. 18(10), pages 1146-1162, October.
    18. World Bank, 2014. "Kyrgyz Republic Public Expenditure Review Policy Notes : Health," World Bank Publications - Reports 19313, The World Bank Group.
    19. Andrew Street & Kirsi Vitikainen & Afsaneh Bjorvatn & Anne Hvenegaard, 2007. "Introducing activity-based financing: a review of experience in Australia, Denmark, Norway and Sweden," Working Papers 030cherp, Centre for Health Economics, University of York.
    20. Munnich, Elizabeth L. & Parente, Stephen T., 2018. "Returns to specialization: Evidence from the outpatient surgery market," Journal of Health Economics, Elsevier, vol. 57(C), pages 147-167.

    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:sae:padigm:v:18:y:2014:i:2:p:121-134. 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: SAGE Publications (email available below). General contact details of provider: .

    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.