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Cost accounting to determine prices: How well do prices reflect costs in the German DRG-system?

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Abstract

Germany has recently introduced a system of Diagnosis Related Groups (DRGs) to engender more appropriate resource allocation. The following article describes the German DRG-system and the methodologies used to determine prices. It analyses the extent to which prices, or calculated cost weights, reflect the actual costs incurred by hospitals for their respective services. We reveal that a “compression” of DRG cost weights occurs, and that the data sample used to calculate cost weights is lacking in terms of its representativeness. Although cost data accuracy has improved over the last few years there are still a number of challenges that need to be addressed.

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References

  1. Lüngen M, Lapsley I (2003) The reform of hospital financing in Germany: an international solution? Journal of Health Organization and Management 17:360–372

    Article  Google Scholar 

  2. Busse R, Riesberg A (2004) Health care systems in transition—Germany. WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies, Copenhagen

    Google Scholar 

  3. Tuschen KH, Trefz U (2004) Krankenhausentgeltgesetz: Kommentar. Kohlhammer, Stuttgart

    Google Scholar 

  4. Institut für das Entgeltsystem im Krankenhaus gGmbH, Definitionshandbuch Band 1, http://www.g-drg.de/, (March 1, 2006)

  5. Busse R, Stargardt T, Schreyögg J (2005) Determining the benefit basket of the Statutory Health Insurance scheme in Germany: methodologies and criteria. European Journal of Health Economics 6(S1):30–36

    Article  Google Scholar 

  6. Carter GM, Newhouse GP, Relles DA (1990) How much change in the case mix index is DRG creep? J Health Econ 9:499–504

    Article  Google Scholar 

  7. Bunzemeier H, Franz D, Fiori W, Hensen P, Rochell B, Roeder N (2004) Zusatzentgelte im DRG-System 2005. FuÉhr wirtsch Krankenh 21:566–574

    Google Scholar 

  8. Roeder N (2006, March 1) Anpassungsbedarf der Vergütungen von Krankenhausleistungen für 2006: Gutachten im Auftrag der Deutschen Krankenhausgesellschaft, http://www.dkgev.de/pdf/826.pdf

  9. Lüngen M, Lauterbach K (2003) DRG in deutschen Krankenhäusern. Schattauer, Stuttgart

    Google Scholar 

  10. Fetter RB (1991) Diagnosis related groups: understanding hospital performance. Interfaces 21:6–26

    Google Scholar 

  11. Institut für das Entgeltsystem im Krankenhaus gGmbH, Abschlussbericht zur Weiterentwicklung des G-DRG-Systems für das Jahr 2006, http://www.g-drg.de/service/download/veroeff_2006/Abschlussbericht_G-DRG-2006-051220.pdf (March 1, 2006)

  12. Finkler SA, Ward DM (1999) Essentials of cost accounting for health care organizations. Aspen, Gaithersburg

    Google Scholar 

  13. Kehres E (2005) Kosten- und Leistungsrechnung im Krankenhaus. In: Hentze J, Huch B, Kehres E (eds) Krankenhaus-Controlling, Kohlhammer, Stuttgart, pp 95–127

    Google Scholar 

  14. Paddock SM, Wynn BO, Carter GM, Buntin MB (2004) Identifying and accommodating statistical outliers when setting prospective payment rates for inpatient rehabilitation facilities. Health Serv Res 39:1859–1880

    Article  Google Scholar 

  15. Cots F, Elvira D, Castells X (2003) Relevance of outlier cases in case mix systems and evaluation of trimming methods. Health Care Manage Sci 6:27–35

    Article  Google Scholar 

  16. Institut für das Entgeltsystem im Krankenhaus gGmbH, Abschlussbericht zur Weiterentwicklung des G-DRG-Systems für das Jahr 2005, http://www.g-drg.de/service/download/veroeff_2005/Abschlussbericht_G-DRG-2005_0412201200.pdf. (March 1, 2006)

  17. Janiszewski J, Larbig M (2002) Unternehmensteuerung unter DRG-Vorzeichen: Das Krankenhaus muss seine Produktkosten kennen. FuÉhr wirtsch Krankenh 19:246–252

    Google Scholar 

  18. Kuntz L, Vera A (2005) Transfer pricing in hospitals and efficiency of physicians: the case of anaesthesia services. Health Care Manage Rev 30:262–269

    Google Scholar 

  19. Lave JR (1985) Is compression occurring in DRG prices? Inquiry 22:142–147

    Google Scholar 

  20. Carter GM, Rogowski JA (1992) How recalibration method, pricing, and coding affect DRG weights. Health Care Financ Rev 14:83–96

    Google Scholar 

  21. Antioch KM, Walsh MK (2004) The risk-adjusted vision beyond casemix (DRG) funding Australia. European Journal of Health Economics 5:95–109

    Article  Google Scholar 

  22. Hensen JP, Fürstenberg T, Luger TA, Steinhoff M, Roeder N (2005) Case mix measures and diagnosis-related groups: opportunities and threats for inpatient dermatology. Eur Acad Dermatol Venereol 19:582–588

    Article  Google Scholar 

  23. Lüngen M, Dredge B, Rose A, Roebuck C, Plamper E, Lauterbach K (2004) Using diagnosis-related groups. European Journal of Health Economics 5:287–289

    Article  Google Scholar 

  24. Jackson T (2001) Using computerised patient-level costing data for setting DRG weights: the Victorian (Australia) cost weight studies. Health Policy 56:149–163

    Article  Google Scholar 

  25. DRG-Projektstelle, Methoden-Pretest zur Vorbereitung der Kalkulation von Fallkosten in einem deutschen DRG-System: Projektbericht, http://www.g-drg.de/service/download/projektbericht011130.pdf (March 1, 2006)

  26. McKinley S (1995) Casemix update: Australian critical care costs and service weights: Part 1. Australian Critical Care 8:10–13

    Google Scholar 

  27. McKinley S (1996) Casemix update: Australian critical care costs and service weights. Part 2. Australian Critical Care 9:56–59

    Google Scholar 

  28. Wiley M (1993) Costing hospital case-mix: the European experience. In: Casas M, Wiley M (eds) Diagnosis related groups in Europe, Springer, Berlin Heidelberg New York

    Google Scholar 

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Correspondence to Jonas Schreyögg.

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Schreyögg, J., Tiemann, O. & Busse, R. Cost accounting to determine prices: How well do prices reflect costs in the German DRG-system?. Health Care Manage Sci 9, 269–279 (2006). https://doi.org/10.1007/s10729-006-9094-0

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