Patient classification and hospital reimbursement for inguinal hernia repair: a comparison across 11 European countries

Purpose This comparative study examines the categorisation of patients undergoing surgical repair of inguinal hernia in the diagnosis-related group (DRG) systems of 11 European countries (Austria, England, Estonia, Finland, France, Germany, Ireland, the Netherlands, Poland, Spain and Sweden). Unders...

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Vydané v:Hernia : the journal of hernias and abdominal wall surgery Ročník 18; číslo 2; s. 273 - 281
Hlavní autori: Serdén, L., O’Reilly, J.
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: Paris Springer Paris 01.04.2014
Springer Nature B.V
Predmet:
Abdominal Surgery
Algorithms
Diagnosis-Related Groups - economics
Europe
Female
Hernia, Inguinal - economics
Hernia, Inguinal - surgery
Herniorrhaphy - economics
Hospital Costs - statistics & numerical data
Humans
Male
Medicine
Medicine & Public Health
Original Article
Europe
Grouping algorithm
Cost
Diagnosis-related groups (DRGs)
Inguinal hernia repair
Length of stay
ISSN:1265-4906, 1248-9204, 1248-9204
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Shrnutí:Purpose This comparative study examines the categorisation of patients undergoing surgical repair of inguinal hernia in the diagnosis-related group (DRG) systems of 11 European countries (Austria, England, Estonia, Finland, France, Germany, Ireland, the Netherlands, Poland, Spain and Sweden). Understanding the design and operation of DRG systems for this common surgical procedure is important, given their increasing use internationally for hospital reimbursement and performance measurement. Methods A common definition was used to identify inguinal hernia patients and the corresponding data were extracted from national databases. The analysis compared the variables and algorithms for classifying these patients to DRGs across the participating countries, as well as the number, composition and relative resource intensity of groups. An index case and six standardised vignettes were grouped using each country’s DRG system and the associated quasi-prices were calculated. Results The number of groups to which inguinal hernia patients are assigned is typically three or four, but ranges from two in Poland to ten in France. In most systems, categorising patients is contingent on procedure, principal and secondary diagnoses, and age, with treatment setting (day case/inpatient) being less common. Added to these, the French system also incorporates length of stay and whether the patient died. More resource intensive DRGs generally contained patients who were older, treated as inpatients, did not die, had (more severe) complications and/or co-morbidities, and/or underwent laparoscopic repair. There are cross-country disparities in day case rates and the use of laparoscopic repairs. Conclusions The categorisation of inguinal hernia patients varies across the 11 European DRG systems under study. By highlighting the main differences across these systems, this comparative analysis allows the relevant decision makers to assess the adequacy and specificity of their own DRG systems.
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ISSN:1265-4906
1248-9204
1248-9204
DOI:10.1007/s10029-013-1158-8