Computerized Medico-Economic Decision Making: An International Comparison

Abstract

A large part of public health care costs come from hospital expenditures. Activity-based payment has gradually become the most common system for hospital reimbursement in high income countries. It was variously implemented over the last decade in order to achieve shared goals such as improving overall efficiency, quality or transparency, and to help in hospital management. Activity-based funding is also supposed to help targeting where and how money is being spent, and thus orient policy and decisions on the behalf of patients. The system also provides for payment adjustments and promotes high quality of care via reward payments.

Different schemes have been adapted to each country according to their individual developmental contexts, or to their conception of a welfare state. Variations relate to differences in the health system models used, the relationships between providers and funders, the degree of centralization, the separation between purchasing and provision, the structure of the hospital market, the type of facilities, or the level of competition between public and private structures.

European countries have adopted rather different regulation and monitoring of health expenditure. To better understand the international complexity of the framework we recalled the basic principles of activity-based payment. We then explored the context of development of activity based payment in five countries: United States, Australia, the United Kingdom, France and Germany. We also described the diagnosis related groups they are based upon, the basis of setting up costs and tariffs, the fields of application, and the regulatory mechanisms.