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Impact of Inpatient Reimbursement Systems on Hospital Performance: The Austrian Case-Based Payment Strategy

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Operations Research and Health Care Policy

Part of the book series: International Series in Operations Research & Management Science ((ISOR,volume 190))

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Abstract

Due to cost-intensive technological advances in high-end medicine and increased life expectancy accompanied by a rising number of multi-morbid elderly people, the health care sector consumes a large part of the gross national product of Austria. As the hospital sector is the main contributor to this increasingly unaffordable cost explosion, reimbursement systems for inpatients worldwide have been undergoing massive restructuring. Case-based systems such as the Austrian performance-oriented LKF-system have been introduced to curb the cost explosion. While macro-perspective studies analyze the efficiency of hospitals based on aggregated input and output data using DEA techniques, micro-perspective studies focus on the main incentives of the LKF-system on several outcome measures using empirical data on inpatients with certain major diseases. This study illustrates its impact on hospitals’ performance as well as on the hospitals’ management subsystem of strategic technology management. Such studies support health regulators in improving their reimbursement schemes by closing loopholes.

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References

  1. Anonymous (2004) Survey: the health of nations. Economist 372(8384):3–4

    Google Scholar 

  2. Crane M (2001) Discharge patients sooner, or we’ll discharge you. Med Econ 78(13):100–101

    Google Scholar 

  3. Cromwell DA, Priddis D, Hindle D (1998) Using simulation to educate hospital staff about casemix. Health Care Manag Sci 1(2):87–93

    Article  Google Scholar 

  4. Czypionka T, Roehrling G, Kraus M, Schnabl A, Eichwalder S (2008) Fondsspitaeler in Oesterreich: ein Leistungs- und Finanzierungsvergleich. Project report, Institute for Advanced Studies, Vienna

    Google Scholar 

  5. Dienesch S, Heitzenberger G (1998) Krankenanstaltenfinanzierung 9 mal anders—Ein Streifzug durch den Finanzierungsdschungel in den oesterreichischen Bundeslaendern. Nycomed, Hallein, Austria

    Google Scholar 

  6. Dezsy J, Fritz R (2000) Analyse und Vorschlaege zur Finanzierung von Gesundheits- leistungen. Oesterreichische Krankenhauszeitung 41(2): 53–58

    Google Scholar 

  7. Ellis R (1998) Creaming, skimping and dumping: provider competition on the intensive and extensive margins. J Health Econ 17(5):537–555

    Article  Google Scholar 

  8. Engelke H, Fricke H (2003) Komplizierte Wiederaufnahmen—Erste Zweifelsfragen bei der Abrechnung von DRGs. Krankenhaus Umschau 72(5):366–367

    Google Scholar 

  9. Federal Ministry of Labour, Health, and Social Affairs (1997) Leistungsorientierte Krankenhausfinanzierung LKF 1998. Federal Ministry of Labour, Health, and Social Affairs, Vienna

    Google Scholar 

  10. Federal Ministry of Health (2006) The Austrian health care system, key facts. Federal Ministry of Health, Vienna

    Google Scholar 

  11. Federal Ministry of Health, Family and Youth (2008) Krankenanstalten in Oesterreich, Hospitals in Austria 2008. Federal Ministry of Health, Family and Youth, Vienna

    Google Scholar 

  12. Federal Ministry of Health (2010) The Austrian health care system, key facts. Federal Ministry of Health, Vienna

    Google Scholar 

  13. Federal Ministry of Health (2010) Leistungsorientierte Krankenhausfinanzierung—LKF—Modell 2011. Federal Ministry of Health, Vienna

    Google Scholar 

  14. Federal Ministry of Health (2010) Leistungsorientierte Krankenhausfinanzierung—LKF—System 2011. Federal Ministry of Health, Vienna

    Google Scholar 

  15. Federal Ministry of Health (2010) Leistungsorientierte Krankenhausfinanzierung—LKF—Aenderungen 2011. Federal Ministry of Health, Vienna

    Google Scholar 

  16. Federal Ministry of Health (2012) www.gesundheit.gv.at. Accessed Mar 2012

  17. Feldstein P (1993) Health care economics. Thomson Delmar Learning, New York

    Google Scholar 

  18. Fetter R (1991) Diagnosis related groups: understanding hospital performance. Interfaces 21(1):6–26

    Article  Google Scholar 

  19. Flemmich G, Ivansits H (1994) Einfuehrung in das Gesundheitsrecht und in die Gesundheits- leistungen. Verlag des Oesterreichischen Gewerkschaftsbundes, Vienna

    Google Scholar 

  20. Flessa S (2007) Grundzuege der Krankenhausbetriebslehre. Muenchen, Oldenbourg

    Book  Google Scholar 

  21. Fuloria P, Zenios S (2001) Outcomes-adjusted reimbursement in a health care delivery system. Manag Sci 47(6):735–751

    Article  Google Scholar 

  22. Geisler E, Heller O (eds) (1996) Managing technology in health care. Kluwer, Boston

    Google Scholar 

  23. Gesundheit Oesterreich GmbH (2010) Austrian health care structure plan. Federal Ministry of Health, Vienna

    Google Scholar 

  24. Gesundheitsplattform Steiermark (2006) LKF-Abrechnungssystem—Steiermark 2006, Beilage zu Top 6c der 3. Sitzung der Gesundheitsplattform, 6 July 2006

    Google Scholar 

  25. Gottlieb S (2007) The war on (expensive) drugs. Wall St J, 30. August, 11–12

    Google Scholar 

  26. Gridchyna I, Aulois-Griot M, Maurain C, Bégaud B (2012) How innovative are pharmaceutical innovations? The case of medicines financed through add-on payments outside of the French DRG-based hospital payment system. Health Policy 104(1):69–75

    Article  Google Scholar 

  27. Guentert B, Klein P, Kriegel J (2005) Fallpauschalierte Entgeltsysteme im Krankenhauswesen—Ein Vergleich von LKF und G-DRG. Wirtschaftspolitische Blaetter 53(4):515–525

    Google Scholar 

  28. Herndl S (2010) Die Evolution des oesterreichischen leistungsorientierten Krankenhausfinanzierungssystems. Master thesis, University of Vienna, Department of Innovation and Technology Management, Austria

    Google Scholar 

  29. Hofmarcher MM, Lietz C, Schnabl A (2005) Inefficiency in Austrian in-patient care: identifying ailing providers based on DEA results. CEJOR 13(4):341–363

    Google Scholar 

  30. Hofmarcher MM, Paterson I, Riedel M (2002) Measuring hospital efficiency in Austria—a DEA approach. Health Care Manag Sci 5(1):7–14

    Article  Google Scholar 

  31. Hofmacher MM, Rack HM (2001) Gesundheitssysteme im Wandel, Kopenhagen: European Observatory on Health Care Systems. European Observatory on Health Care Systems: Gesundheitssysteme im Wandel—Oesterreich 2001, Kopenhagen 2001

    Google Scholar 

  32. Hofmacher MM, Rack HM (2006) Health care systems in transition. European Observatory on Health Care Systems, Kopenhagen, Austria

    Google Scholar 

  33. Hofmarcher MM, Riedel M (2001) Gesundheitsausgaben in der EU: Ohne Privat kein Staat, Schwerpunktthema. Das oesterreichische Krankenanstaltenwesen—eines oder neun Systeme? Health System Watch, No. 1. Institute for Advanced Studies, Vienna

    Google Scholar 

  34. Hsia D, Ahern C, Ritchie B, Moscoe LM, Krushat WM (1992) Medicare reimbursement accuracy: under the prospective payment system, 1985 to 1988. J Am Med Assoc 268(7):896–899

    Article  Google Scholar 

  35. Ingruber H (1994) Krankenhausbetriebslehre. Goeschl, Vienna.

    Google Scholar 

  36. Kraus M, Rauner MS, Schwarz S (2010) Operations research and management games with a special focus on health care games. CEJOR 18(4):567–591

    Article  Google Scholar 

  37. Kuntz L, Scholtes S, Vera A (2007) Incorporating efficiency in hospital-capacity planning in Germany. Eur J Health Econ 8(3):213–223

    Article  Google Scholar 

  38. Leidl R (ed) (1998) Health care and its financing in the single European market. IOS Press, Amsterdam

    Google Scholar 

  39. Leonard KJ, Rauner MS, Schaffhauser-Linzatti MM, Yap R (2003) The effect of funding policy on day of week admissions and discharges in hospitals: the cases of Canada and Austria. Health Policy 63(3):239–257

    Article  Google Scholar 

  40. Neubauer G, Demmler G (1991) Bausteine eines rationalen Krankenverguetungssystems. In: Neubauer G, Sieben G (eds) Alternative Entgeltverfahren in der Krankenhausversorgung: Beitraege zur Gesundheitsoekonomie, 24th edn. Gerlingen, Bleicher, pp 13–42

    Google Scholar 

  41. Neubauer G, Sonnenholzner-Roche A, Unterhuber H (1987) Die Problematik einer Fallgruppenbildung im Krankenhaus. Krankenhaus Umschau 56(1):27–34

    Google Scholar 

  42. Newhouse J (1996) Reimbursing health plans and health providers: efficiency in production versus selection. J Econ Lit 34(3):1236–1263

    Google Scholar 

  43. OECD (2012) Country-specific statistical profiles. http://www.oecd-ilibrary.org/economics. Accessed Mar 2012

  44. Pfeiffer KP (1996) The possible effects of a new hospital financing system in Austria. In: Schwartz W, Glennester H, Saltman R (eds) Fixing health budgets: experience from Europe and North America, Chichester. Wiley, Chichester, pp 203–212

    Google Scholar 

  45. Rauner MS (2007) Ein Rueckblick auf die Leistungsorientierte Krankenhausfinanzierung in Oesterreich von 1997–2006 unter besonderer Beruecksichtung der Anreizwirkungen auf Krankenhaeuser. In: Braeuning D, Greiling D (eds) Stand und Perspektiven der oeffentlichen Betriebswirtschaftslehre, Festschrift fuer Professor Dr. Peter Eichhorn. Berliner Wissenschaftsverlag, Berlin, pp 163–175

    Google Scholar 

  46. Rauner MS, Heidenberger K (2002) Scope and role of strategic technology management in hospitals: the case of Vienna, Austria. Int J Healthc Technol Manag 4(3/4):239–258

    Article  Google Scholar 

  47. Rauner MS, Heidenberger K, Hermescec D, Mokic A, Zsifkovits M (2011) Scope and role of technology management in Vienna hospitals. Int J Healthc Technol Manag 12(3/4):250–279

    Article  Google Scholar 

  48. Rauner MS, Schwarz S, Kraus M (2008) Competition under different reimbursement systems: the concept of an internet-based hospital management game. Eur J Oper Res 185(3):948–963

    Article  Google Scholar 

  49. Rauner MS, Schaffhauser-Linzatti MM (1999) Evaluation of the new Austrian in-patient reimbursement system. In: De Angelis V, Ricciardi N, Storchi G (eds) Monitoring, evaluating, planning health services, Proceedings of the 24th meeting of the European working group on operational research applied to health services, Rome, Italy, July 19–24, 1998, World Scientific Publishing, Singapore, pp 221–233

    Google Scholar 

  50. Rauner MS, Schaffhauser-Linzatti MM (2001) Interplay between in-patient reimbursement systems and health care technology management: the Austrian case. Int J Healthc Technol Manag 3(1–2):1–23

    Article  Google Scholar 

  51. Rauner MS, Schaffhauser-Linzatti M-M (2002) Impact of international in-patient payment strategies on health technology management: a system-dynamics-model for Austria. Socioecon Plann Sci 36(3):133–154

    Article  Google Scholar 

  52. Rauner MS, Schneider G, Heidenberger K (2005) Reimbursement systems and regional in-patient allocation: a non-linear optimisation model. IMA J Manag Math 16(3):217–237

    Article  Google Scholar 

  53. Rauner MS, Zeileis A, Schaffhauser-Linzatti MM, Hornik K (2003) Modelling the effects of the Austrian in-patient reimbursement system on length-of-stay distributions. OR-Spectrum 25(2):183–206

    Article  Google Scholar 

  54. Schaffhauser-Linzatti MM, Rauner MS (2008) Quo vadis Leistungsorientierte Krankenhausfinanzierung? Oesterreichische Erfahrungen und Perspektiven. In: Schauer R, Helmig B, Purtschert R, Wirt D (eds) Steuerung und Kontrolle in Nonprofit-Organisationen, 8. Colloquium der NPO-Forscher im deutschsprachigen Raum, Johannes Kepler Universität Linz, 17.-18. April 2008. Trauner, Linz, pp 335–364

    Google Scholar 

  55. Schaffhauser-Linzatti MM, Zeileis A, Rauner M (2009) Effects of the Austrian performance-oriented in-patient reimbursement system on treatment patterns: illustrated on cases with knee-joint problems. CEJOR 17(3):293–314

    Article  Google Scholar 

  56. Sebek W (2009) Entwicklung des LKF-Systems 1997–2009. http://www.prikraf.at/forum/lkf2009/pdf/Beitrag_Sebek.pdf. Accessed 5 Oct 2009

  57. Selbmann HK (2005) Es entstehen neue Problemzonen—Bedeutung des Qualitaetsmanagements im DRG-Zeitalter. Krankenhaus Umschau, ku-Special Controlling 74(4):8–11

    Google Scholar 

  58. Sommersguter-Reichmann M (2000) The impact of the Austrian hospital financing reform on hospital productivity: empirical evidence on efficiency and technology changes using a non-parametric input-based Malmquist approach. Health Care Manag Sci 3(4):309–321

    Article  Google Scholar 

  59. Sommersguter-Reichmann M (2003) Analysing hospital productivity changes using non-parametric approaches. OR Spectrum 25(2):145–160

    Google Scholar 

  60. Sommersguter-Reichmann M, Stepan A (2000) Evaluating the new activity-based hospital financing system in Austria. In: Dockner E, Hartl R, Luptacik M, Sorger G (eds) Optimization, dynamics, and economic analysis. Physika, Heidelberg, pp 49–63

    Chapter  Google Scholar 

  61. Stepan A (1985) Moeglichkeiten eines leistungsgerechten Finanzierungssystems fuer oesterreichische Krankenhaeuser. Zeitschrift für oeffentliche und gemeinnuetzige Unternehmen 8(4):432–445

    Google Scholar 

  62. Stepan A, Sommersguter-Reichmann M (1999) Priority setting in Austria. Health Policy 50(1–2):91–104

    Article  Google Scholar 

  63. Stepan A, Sommersguter-Reichmann M (2002) Analyse des neuen leistungsorientierten Krankenanstalten-Finanzierungssystems in Österreich. In: Wille E (ed) Anreizkompatible Verguetungssysteme im Gesundheitswesen, Gesundheitsoekonomische Beitraege, Vol. 38. Baden-Baden, Nomos, pp 109–141

    Google Scholar 

  64. Taheri PA, Butz DA, Greenfield LJ (2000) Length-of-stay has minimal impact on the cost of hospital admission. J Am Coll Surg 191(2):123–130

    Article  Google Scholar 

  65. Theurl E, Winner H (2005) Die Reform der Krankenhausfinanzierung in Oesterreich und ihre Auswirkungen auf die Verweildauer. Wirtschaftspolitische Blaetter 52(4):504–514

    Google Scholar 

  66. Vaul JH (1998) DRG benchmarking study establishes national coding norms. Healthc Financ Manage 52(8):52–54

    Google Scholar 

  67. Westphal E (1996) Fallbezogene Krankenhausfinanzierung und Monistik—Kostendaempfung nach dem Beispiel von Oesterreich. Die Krankenversicherung 47:220–223

    Google Scholar 

  68. Wray N, Petersen NJ, Souchek J, Ashton CM, Hollingsworth JC, Geraci JM (1999) The hospital multistay rate as an indicator of quality of care. Health Serv Res 34(3):777–790

    Google Scholar 

  69. Zakoworotny C (1993) Strategies to optimize DRG reimbursement. Topics in Health Care Financing 20(1):53–60

    Google Scholar 

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Acknowledgments

Special thanks are due to Wolfgang Bartosik of the Federal Ministry of Health who has provided us with all essential data on the LKF-system since 1997. We are also grateful to several students who surveyed data on Austrian hospitals and the LKF-system, especially Sabrina Herndl who investigated key data on the LKF-system for the years 1997 to 2010. We are indebted to practitioners at Austrian hospitals for providing us with hospital-specific data.

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Authors and Affiliations

  1. Department of Innovation and Technology Management, University of Vienna, Bruenner Str. 72, 1210, Vienna, Austria

    Marion S. Rauner

  2. Department of External Accounting, University of Vienna, Bruenner Str. 72, 1210, Vienna, Austria

    Michaela M. Schaffhauser-Linzatti

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  1. Marion S. Rauner
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  2. Michaela M. Schaffhauser-Linzatti
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Correspondence to Marion S. Rauner .

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  1. , Ivey School of Business, University of Western Ontario, London, N6A 3K7, Ontario, Canada

    Gregory S. Zaric

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Rauner, M.S., Schaffhauser-Linzatti, M.M. (2013). Impact of Inpatient Reimbursement Systems on Hospital Performance: The Austrian Case-Based Payment Strategy. In: Zaric, G. (eds) Operations Research and Health Care Policy. International Series in Operations Research & Management Science, vol 190. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6507-2_7

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