Childbirth and Diagnosis Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries

Martine Bellanger (), Wilm Quentin and Siok Swan Tan
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Martine Bellanger: EHESP - École des Hautes Études en Santé Publique [EHESP], EA MOS - EA Management des Organisations de Santé - EHESP - École des Hautes Études en Santé Publique [EHESP] - PRES Sorbonne Paris Cité
Siok Swan Tan: Department of Chemical Engineering [Stanford] - Stanford University

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Abstract: Objectives The study compares how Diagnosis-Related Group (DRG) based hospital payment systems in eleven European countries (Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) deal with women giving birth in hospitals. It aims to assist gynaecologists and national authorities in optimizing their DRG systems. Methods National or regional databases were used to identify childbirth cases. DRG grouping algorithms and indicators of resource consumption were compared for those DRGs which account for at least 1% of all childbirth cases in the respective database. Five standardized case vignettes were defined and quasi prices (i.e. administrative prices or tariffs) of hospital deliveries according to national DRG-based hospital payment systems were ascertained. Results European DRG systems classify childbirth cases according to different sets of variables (between one and eight variables) into diverging numbers of DRGs (between three and eight DRGs). The most complex DRG is valued 3.5 times more resource intensive than an index case in Ireland but only 1.1 times more resource intensive than an index case in The Netherlands. Comparisons of quasi prices for the vignettes show that hypothetical payments for the most complex case amount to only €479 in Poland but to €5532 in Ireland. Conclusions Differences in the classification of hospital childbirth cases into DRGs raise concerns whether European systems rely on the most appropriate classification variables. Physicians, hospitals and national DRG authorities should consider how other countries' DRG systems classify cases to optimize their system and to ensure fair and appropriate reimbursement.

Keywords: Childbirth; Delivery; Diagnosis-Related Groups; Europe; Economics; Hospital (search for similar items in EconPapers)
Date: 2013-01-30
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Citations: View citations in EconPapers (1)

Published in European Journal of Obstetrics & Gynecology and Reproductive Biology, 2013, 168 (1), pp.12 - 19. ⟨10.1016/j.ejogrb.2012.12.027⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-01505629

DOI: 10.1016/j.ejogrb.2012.12.027

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