The effects of upcoding, cream skimming and readmissions on the Italian hospitals efficiency: A population-based investigation

Paolo Berta, Giuditta Callea, Gianmaria Martini and Giorgio Vittadini ()

Economic Modelling, 2010, vol. 27, issue 4, 812-821

Abstract: In this paper we analyze the effects of some distortions induced by the prospective payment system, i.e. upcoding, cream skimming and readmissions, on hospitals' technical efficiency. We estimate a production function using a population-based dataset composed by all active hospitals in an Italian region during the period 1998-2007. We show that cream skimming and upcoding have a negative impact on hospitals' technical efficiency, while readmissions have a positive effect. Moreover, the results indicate that private hospitals engage more in cream skimming than public and not-for-profit ones, while we observe no ownership differences regarding upcoding. Not-for-profit hospitals have the highest readmission index. Last, not-for-profit and public hospitals have the same efficiency levels, while private hospitals have the lowest technical efficiency.

Keywords: Upcoding; Cream; skimming; Readmission; Hospital; technical; efficiency; Ownership (search for similar items in EconPapers)
Date: 2010
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (39)

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Working Paper: The effects of upcoding, cream skimming and readmissions on the Italian hospitals efficiency: a population–based investigation (2009)
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Persistent link: https://EconPapers.repec.org/RePEc:eee:ecmode:v:27:y:2010:i:4:p:812-821

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