New approaches to reimbursement schemes based on PCSS and their comparison

[Abstract] OBJECTIVES: We propose innovative reimbursement schemes based on Patient classification Systems that include adjustments for length of stay and exceptional costs. The schemes are designed to minimize undesirable effects of economic incentives. In addition, a statistical approach to compare these schemes as well as the underlying classification systems is proposed. Both the reimbursement schemes and the statistical approach use cost and length of stay data for two successive years. First year data are used to compute estimates of class cost means and to determine the next year's reimbursements. The reimbursements are then compared to the second year's observed costs. This method focuses on the predictive power of a classification system and basically differs from the usual retrospective analyses based on the proportion of explained variance for single year data. DATA AND RESULTS: The approach is applied to discharge data from 67'137 stays in 2002 and 60'701 stays for 2003 of Swiss hospitals. These stays are grouped according to five classification systems: AP-DRGs (All patient DRGs), APR-DRGs (All Patient Refined DRGs), IR-DRGs (International Refined DRGs), AR-DRGs (Australian Refined DRGs) and SQLape. We find that, when adjusting for length of stay and outliers, these systems do not differ substantially in their ability to predict the cost of hospitals stays. CONCLUSIONS: We conclude that a classification system with a large number of classes does not necessarily provide a better cost prediction compared to a simpler one. However, the payment of a fixed amount per diem that does not exceed the marginal cost per diem (e.g., 200 CHF) and the introduction of a simple correction for exceptional costs into the reimbursement scheme substantially reduces the average discrepancy between costs and reimbursements. [Authors]]]> Length of Stay ; Insurance, Health, Reimbursement eng oai:serval.unil.ch:BIB_9FF24D667A77 2023-07-29T01:31:23Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_9FF24D667A77 Insuffisance rénate chronique: attitudes et pratiques de dépistages en l'absence d'etudes randomisées. [Chronic kidney disease: screening attitude and practice in the absence of randomized controlled trials]. info:eu-repo/semantics/altIdentifier/pmid/20701016 Ponte, Belén Martin, Pierre-Yves Pechère, Antoinette Burnier, Michel Guessous, Idris info:eu-repo/semantics/article article 2010 Revue Médicale Suisse, vol. 6, no. 256, pp. 1400-1404 info:eu-repo/semantics/altIdentifier/pissn/1660-9379[print], 1660-9379[linking] <![CDATA[Au vu de l'augmentation de la prévalence de l'insuffisance rénale chronique (IRC), une détection précoce a été proposée. Certaines organisations de santé proposent des mesures de détection précoce (par exemple : taux de filtration glomérulaire). L'efficacité du dépistage de l'IRC n'est cependant pas connue puisqu'aucune étude randomisée contrôlée n'a été conduite. Si le test de dépistage de l'IRC est simple et peu onéreux, un dépistage n'est justifié que s'il améliore le pronostic par rapport à l'absence de dépistage avec un rapport risques-bénéfices favorable et un rapport coût-efficacité acceptable. Sur la base d'études observationnelles et de modèles de rapport coût-efficacité, le dépistage de l'IRC doit être proposé chez les patients hypertendus et/ou diabétiques mais pas dans la population générale. [Abstract] Given the increasing prevalence of chronic kidney disease (CKD), early detection has been proposed. Some organizations recommend CKD screening. Yet, the efficacy of CKD screening is unknown given the absence of randomized controlled trial conducted so far. While CKD screening tests (e.g., glomerular filtration rate) are simple and inexpensive, CKD screening can only be justified if it reduces CKD-related mortality and/or CKD-related morbidity compared to no screening. In addition, CKD screening must provide more benefits than risks to the participants and must be cost-effective. Based on observational studies and cost-effectiveness models, CKD screening has to be proposed to high risk population (patients with hypertension and/or diabetes) but not to the general population