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

Klaus Kaier (), Martin Wolkewitz (), Philip Hehn (), Nico T. Mutters () and Thomas Heister ()
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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

International Journal of Health Economics and Management, 2020, vol. 20, issue 1, No 1, 11 pages

Abstract: 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

Keywords: HAI; G-DRG; Incentives; Reimbursement; Cost (search for similar items in EconPapers)
JEL-codes: I10 (search for similar items in EconPapers)
Date: 2020
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DOI: 10.1007/s10754-019-09267-w

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