Januleviciute Jurgita, Askildsen Jan Erik, Kaarboe Oddvar, Siciliani Luigi, Sutton Matt
Health Economics Bergen, Bergen, Norway.
Department of Economics, University of Bergen, Bergen, Norway.
Health Econ. 2016 May;25(5):620-36. doi: 10.1002/hec.3179. Epub 2015 Apr 30.
Many publicly funded health systems use activity-based financing to increase hospital production and efficiency. The aim of this study is to investigate whether price changes for different treatments affect the number of patients treated and the mix of activity provided by hospitals. We exploit the variations in prices created by the changes in the national average treatment cost per diagnosis-related group (DRG) offered to Norwegian hospitals over a period of 5 years (2003-2007). We use the data from Norwegian Patient Register, containing individual-level information on age, gender, type of treatment, diagnosis, number of co-morbidities and the national average treatment costs per DRG. We employ fixed-effect models to examine the changes in the number of patients treated within the DRGs over time. The results suggest that a 10% increase in price leads to about 0.8-1.3% increase in the number of patients treated for DRGs, which are medical (for both emergency and elective patients). In contrast, we find no price effect for DRGs that are surgical (for both emergency and elective patients). Moreover, we find evidence of upcoding. A 10% increase in the ratio of prices between patients with and without complications increases the proportion of patients coded with complications by 0.3-0.4 percentage points.
许多公共资助的医疗系统采用基于活动的融资方式来提高医院的产出和效率。本研究的目的是调查不同治疗价格的变化是否会影响治疗的患者数量以及医院提供的服务组合。我们利用了挪威医院在5年期间（2003 - 2007年）每个诊断相关组（DRG）的全国平均治疗成本变化所产生的价格差异。我们使用了挪威患者登记处的数据，其中包含有关年龄、性别、治疗类型、诊断、合并症数量以及每个DRG的全国平均治疗成本的个体层面信息。我们采用固定效应模型来研究随着时间推移DRG内治疗患者数量的变化。结果表明，价格上涨10%会导致医疗类DRG（包括急诊和择期患者）的治疗患者数量增加约0.8 - 1.3%。相比之下，我们发现外科类DRG（包括急诊和择期患者）不存在价格效应。此外，我们发现了编码升级的证据。有并发症和无并发症患者之间的价格比上涨10%会使编码有并发症的患者比例提高0.3 - 0.4个百分点。
