From downcoding to upcoding: DRG based payment in hospitals

Carine Milcent

International Journal of Health Economics and Management, 2021, vol. 21, issue 1, No 1, 26 pages

Abstract: Abstract A prospective disease group-based payment is a reimbursement rule used in a wide array of countries. It turns to be the hospital’s payment rule to imply. The secret of this payment is a fee payment as well as a hospital’s activity based payment. There is a consensus to consider this rule of payment as the least likely to be manipulated by the actors. However, the defined fee per group depends on recorded information that is then processed using complex algorithms. What if the data itself can be manipulated? The result would be a fee per group based on manipulated factors that would lead to an inefficient budget allocation between hospitals. Using a unique French longitudinal database with 145 million stays, I unambiguously demonstrate that the implementation of a finer classification led to an upcoding-learning effect. The end result has been a budget transfer from public non-research hospitals to for-profit hospitals. The 2009 policy lead to upcoding disconnected from any changes in the trend of production of care.

Keywords: Hospital stays; Diagnosis-related groups (DRGs); Upcoding; Manipulated database; Heterogeneity in responses (search for similar items in EconPapers)
JEL-codes: I18 (search for similar items in EconPapers)
Date: 2021
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (5)

Downloads: (external link)
http://link.springer.com/10.1007/s10754-020-09287-x Abstract (text/html)
Access to full text is restricted to subscribers.

Related works:
Working Paper: From downcoding to upcoding: DRG based payment in hospitals (2021)
Working Paper: From downcoding to upcoding: DRG based payment in hospitals (2021)
Working Paper: From downcoding to upcoding: DRG based payment in hospitals (2019)
Working Paper: From downcoding to upcoding: DRG based payment in hospitals (2019)
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:kap:ijhcfe:v:21:y:2021:i:1:d:10.1007_s10754-020-09287-x

Ordering information: This journal article can be ordered from
http://www.springer. ... th/journal/10754/PS2

DOI: 10.1007/s10754-020-09287-x

Access Statistics for this article

International Journal of Health Economics and Management is currently edited by Leemore Dafny, Robert Town, Mark Pauly, David Dranove and Pedro Pita Barros

More articles in International Journal of Health Economics and Management from Springer
Bibliographic data for series maintained by Sonal Shukla () and Springer Nature Abstracting and Indexing ().