COHERE, Department of Business and Economics, University of Southern Denmark, Campusvej 55, Odense M, DK-5230, Denmark.
Soc Sci Med. 2017 Jun;183:116-125. doi: 10.1016/j.socscimed.2017.04.036. Epub 2017 Apr 26.
Treatment costs are found to vary substantially and systematically within DRGs. Several factors have been shown to contribute to the variation in costs within DRGs. We argue that readmissions might also explain part of the observed variation in costs. A substantial number of all readmissions occur to a different hospital. The change in hospital indicates that a progression of the illness has occurred since the initial hospitalisation. As a result, different-hospital readmissions might be more costly compared to same-hospital admissions. The aim of this paper is twofold. Firstly, to analyse differences in costs between different-hospital readmissions and same-hospital readmissions within the same DRG. Secondly, to investigate whether the effect of different-hospital readmission on costs vary depending of provider type (general versus teaching hospital). We use a rich Danish patient-level administrative data set covering inpatient stays in the period 2008-2010. We exploit the fact that some patients are readmitted within the same DRG and that some of these readmissions occur at different hospitals in a propensity score difference-in-difference design. The estimates are based on a restricted sample of n = 328 patients. Our results show that the costs of different-hospital readmissions are significantly higher relative to the costs of same-hospital readmission (approx. €777). Furthermore, the cost difference is found to be almost twice the size for patients readmitted to a teaching hospital (approx. €1016) (P < 0.10) compared to patients readmitted to a different general hospital (approx. €511) (P < 0.10). The results suggest that hospitals in general face a potential risk by treating different-hospital readmissions, and that the financial consequences are highest among teaching hospitals. If teaching hospitals are not compensated for the additional costs of treating different-hospital readmission patients, they might be unfairly funded under a DRG-based payment scheme.
治疗成本在 DRGs 内存在显著且系统的差异。有几个因素被证明会导致 DRGs 内成本的差异。我们认为，再次入院也可能解释了部分观察到的成本变化。大量的再次入院发生在不同的医院。医院的变化表明，自最初住院以来，疾病已经有所进展。因此，与同一医院的再次入院相比，不同医院的再次入院可能更为昂贵。本文的目的有两个。首先，分析同一 DRG 内不同医院再次入院和同一医院再次入院之间的成本差异。其次，研究不同医院再次入院对成本的影响是否因提供者类型（普通医院与教学医院）而异。我们使用了一个丰富的丹麦患者级别的行政数据集，涵盖了 2008-2010 年期间的住院治疗。我们利用了一些患者在同一 DRG 内再次入院的事实，以及其中一些再次入院发生在不同医院的情况，采用倾向评分差异中的差异设计。估计是基于一个受限的 n=328 名患者的样本。我们的结果表明，与同一医院再次入院相比，不同医院再次入院的成本显著更高（约 777 欧元）。此外，对于被送往教学医院的患者（约 1016 欧元）（P<0.10），与被送往其他普通医院的患者（约 511 欧元）（P<0.10）相比，成本差异几乎是后者的两倍。研究结果表明，一般来说，医院在治疗不同医院的再次入院患者时面临潜在的风险，而这种财务后果在教学医院中最高。如果教学医院没有因治疗不同医院再次入院患者的额外成本而得到补偿，那么在基于 DRG 的支付方案下，它们可能会受到不公平的资助。
