Abstract
The extent of random financial risk involved in the Finnish bed-day and Diagnosis Related Groups (DRG) based hospital pricing systems were estimated and compared using parametric and simulation methods. DRG based payment schemes were found to provide significantly better protection against financial risk for municipalities, but municipality's size was the main determinant of financial risk. Small municipalities should use longer contracts between hospitals or form bigger purchaser-organisations for risk pooling. In addition, the current risk management system proved to be ineffective in decreasing the random variation in total costs.
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References
K. Arrow, Uncertainty and the welfare economics of medical care, American Economic Review 53 (1963) 941–973.
E. Schokkaert, G. Dhaene and C. Voorde, Risk adjustment and the trade-off between efficiency and risk selection: An application of the theory of fair compensation, Health Economics 7 (1998) 465–480.
E.M. van Barneveld, L.M. Lamers, R.C.J.A. van Vilet and W.P.M.M. van de Ven, Risk sharing as a supplement to imperfect capitation a tradeoff between selection and efficiency, Journal of Health Economics 20 (2001) 147–168.
R.F. Coulam and G.L. Gaumer, Medicare's prospective payment system: A critical appraisal, Health Care Financing Review, Annual supplement (1991) 45–77.
C. Charpentier and L.A. SamuelsonEffekter av en Sjukvårdsreform (Impacts of a Health Care Reform) (Nerenius & Santérus Förlag, Sollentuna, 1999).
E. Forsberg, R. Axelsson and B. Arnetz, Financial incentives in health care. The Impact of performance-based reimbursement, Health Policy 58 (2001) 243–262.
T. Hagen, T. Iverse and J. Magnussen, Sykehusenes effektivitetsutvikling 1992–1999: Hvilke effekter ga Innsatsstyrt finansiering? (The effect of activity based financing on hospital efficiency) (HERO Skriftserie 5, Oslo, 2001).
E. Kjerstad, Prospective Funding of Somatic Hospitals in Norway – Incentives for Higher Production? (Foundation for Research in Economic and Business Administration, Bergen, 1999).
M. Bachman and G. Bevan, Determining the size of a total purchasing site to manage the financial risks of rare costly referrals: Computer simulation model, BMJ 313 (1996) 1054–1057.
B. Crumb, J. Cubbon, M. Drummond, R. Hawkes and M. Marchment, Fundholding in general practise and financial risk, BMJ 303 (1991) 1582–1584.
L. Gpenski and B. Langland-Orban, The financial risk to hospitals inherent in DRG, per diem, and capitation reimbursement methodologies, Journal of Health Care Management 43 (1998) 323–338.
U. Häkkinen, M. Linna and M. Salonen, Korvausmenettelyn ja kuntakoon vaikutus erikoissairaanhoidon taloudelliseen riskiin (The effect of hospital pricing and size of municipality on the financial risk in specialised care), Suomen Lääkärilehti 25 (1994) 2454–2458.
C. Siegel, K. Jones, E. Laska, M. Meisner and S. Lin, A risk-based prospective payment system that integrates patient, hospital and national costs, Journal of Health Economics 11 (1992) 1–41.
H. Barnum, J. Kutzin and H. Saxenian, Incentives and provider payment methods, International Journal of Health Planning and Management 10 (1995) 23–45.
S. Shavell, Sharing risks of deferred payment, Journal of Political Economy 84 (1976) 161–168.
M. Hornbrook, Economic incentives and control, Journal of Medical Systems 5 (1981) 69–96.
R. Ellis and T. McGuire, Provider behaviour under prospective reimbursement, cost sharing and supply, Journal of Health Economics 5 (1986) 129–151.
H. Panjer, Recursive evaluation of a family of compound distributions, ASTIN Bulletin 12 (1981) 22–26.
H. Panjer and S. Wang, On the stability of recursive formulas, ASTIN Bulletin 23 (1993) 227–258.
B. Efron and R. Tibshirani, An Introduction to the Bootstrap (Chapman & Hall, New York, 1993).
K.-H. Waldmann, Modified recursions for a class of compound distributions, ASTIN Bulletin 26 (1996) 213–224.
S. Mustonen, SURVO – An Intergrated Environment for Statistical Computing and Related Areas (Survo Systems, Helsinki, 1992).
S. Mustonen, Programming SURVO, in: C. SURVO Contributions, Vol. 3 (Department of Statistics, University of Helsinki, Helsinki, 1989).
R. Ellis and T. McGuire, Insurance principles and the design of prospective payment systems, Journal of Health Economics 7 (1988) 215–237.
E. Keeler, G. Carter and S. Trude, Insurance aspects of DRG outlier payments, Journal of Health Economics 7 (1988) 193–214.
B.H. Gilman, Hospital response to DRG refinements: The impact of multiple reimbursement incentives on inpatient length of stay, Health Economics 9 (2000) 277–294.
H. Mikkola, I. Keskimäki and U. Häkkinen, DRG related prices applied in a public health care system – can Finland learn form Norway or Sweden, Health Policy 59 (2002) 37–51.
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Mikkola, H., Sund, R., Linna, M. et al. Comparing the Financial Risk of Bed-Day and DRG Based Pricing Types Using Parametric and Simulation Methods. Health Care Management Science 6, 67–74 (2003). https://doi.org/10.1023/A:1023341000858
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DOI: https://doi.org/10.1023/A:1023341000858