Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-08T22:35:18.287Z Has data issue: false hasContentIssue false
  • English
  • Français

Opening the black box of diagnosis-related groups (DRGs): unpacking the technical remuneration structure of the Dutch DRG system

Published online by Cambridge University Press:  27 July 2018

Sam van Herwaarden ,
Iris Wallenburg ,
Joris Messelink  and
Roland Bal
Sam van Herwaarden
Affiliation:
Intelligence to Integrity (i2i), Amsterdam, The Netherlands
Iris Wallenburg*
Affiliation:
Assistant Professor of Healthcare Governance, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
Joris Messelink
Affiliation:
Intelligence to Integrity (i2i), Amsterdam, The Netherlands
Roland Bal
Affiliation:
Full Professor of Healthcare Governance, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
*
*Correspondence to: Iris Wallenburg, Erasmus School of Health Policy & Management, Erasmus Universiteit Rotterdam, iBMG, 3000 DR Rotterdam, The Netherlands. Email: wallenburg@eshpm.eur.nl
Get access Rights & Permissions [Opens in a new window]

Abstract

While we know that upcoding of diagnosis-related groups (DRGs) regularly occurs, we have little knowledge of the role of the technical features of coding systems in inducing coding behaviour. This paper presents methods for investigating the financial structure of the Dutch DRG system, and more in particular the grouper software, to gain such insight. The paper describes a system for investigating the robustness of the reward structure, by simulating the response of the DRG system to small changes in individual coding. The results from these analyses are used to visualise some data on coding behaviour, and to investigate how this behaviour is affected by incentives in the technical features of the DRG system. A number of technical weaknesses in the system are also identified.

Keywords

DRGgrouperupcoding
Type
Articles
Information
Health Economics, Policy and Law , Volume 15 , Issue 2 , April 2020 , pp. 196 - 209
Copyright
© Cambridge University Press 2018

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bal, R and Zuiderent-Jerak, T (2011) The practice of markets in Dutch healthcare: are we drinking from the same glass? Health Economics Policy and Law 6(1): 139–145.CrossRefGoogle ScholarPubMed
Barros, P and Braun, G (2016) Upcoding in a national health service: the evidence from Portugal. Health Economics 26(5), 600–618.CrossRefGoogle Scholar
Bowker, GC and Star, SL (1999) Sorting Things Out: Classification and its Consequences. Cambridge, MA: MIT Press.Google Scholar
Busse, R, Geissler, A, Aaviksoo, A, Cots, F, Häkkinen, U, Kobel, C, Mateus, C, Zeynep, O, O’Reilly, J, Serdén, L, Street, A, Swan Tan, S and Quentin, W (2013) Diagnosis related groups in Europe: moving towards transparency, efficiency, and quality in hospitals?. BMJ 346, f3179.CrossRefGoogle ScholarPubMed
Eijkenaar, F (2013) Key issues in the design of pay-for-performance. European Journal of Health Economics 14, 117–131.CrossRefGoogle ScholarPubMed
Helderman, JK, Schut, F, van der Grinten, TED and van de Ven, WPMM (2005) Martket-oriented health care reforms and policy learning in the Netherlands. Journal of Health Policy, Politics and Law 30(1–2), 189–210.CrossRefGoogle ScholarPubMed
Januleviciute, J, Askilden, JE, Kaarboe, O, Siciliani, L and Sutton, M (2016) How do hospitals respond to price changes? Evidence from Norway. Health Economics 25, 620–636.CrossRefGoogle ScholarPubMed
Kerpershoek, E (2015) Medical Professionals’ Responses to a DRG Performance Management System for Hospital Care in the Netherlands. Reinterpreting “Perverse Effects”, such as Upcoding and Patient Selection, Using Arguments of Professionalism and Managerialism PhD, Delft University of Technology, Delft.Google Scholar
Kerpershoek, E, Groenleer, M and de Bruijn, H (2016) Unintended responses to performance management in Dutch hospital care: bringing together the managerial and professional perspective. Public Management Review 18(3), 417–436.CrossRefGoogle Scholar
Melberg, HO, Beck Olsen, C and Pedersen, K (2016) Did hospitals respond to changes in weights of diagnosis related treatment groups in Norway between 2006 and 2013?. Health Policy 120(9), 992–1000.CrossRefGoogle ScholarPubMed
Oostenbrink, JB and Rutten, FFH (2006) Cost assessment and price setting of inpatient care in the Netherlands: the DBC case-mix system. Health Care Management Science 9(3), 287–294.CrossRefGoogle ScholarPubMed
Silverman, EM and Skinner, JSM (2004) Medicare upcoding and hospital ownership. Journal of Health Economics 23(2), 369–389.CrossRefGoogle ScholarPubMed
Simborg, DW (1981) DRG creep: a new hospital-acquired disease. The New England Journal of Medicine 304(26): 1602–1604.CrossRefGoogle ScholarPubMed
Steinbusch, PJM, Oostenbrink, JB, Zuurbier, JJ and Schaepkens, FJM (2007) The risk of upcoding in casemix systems: a comparative study. Health Policy 81, 289–299.CrossRefGoogle ScholarPubMed
Taal, M and Rypkema, W (2014) Toezicht in de zorg: gedrag sturen door benchmarks en gesprekken. Tijdschrift voor Toezicht 3(5), 43–51.Google Scholar
Tan, SS, Boumans, CAM and Hakkaart, L (2014a) A Dutch Administrative Database in Support of Economic Evaluations ISPOR, 8–12 November 2014, Amsterdam.Google Scholar
Tan, SS, Geissler, A, Serdén, L, Heurgren, B, van Ineveld, M, Redekop, WK and Hakkaart-van Roijen, L (2014b) DRG systems in Europe: variations in cost accounting systems among 12 countries. European Journal of Public Health 24(6), 1023–1028.CrossRefGoogle ScholarPubMed
van Erp, J, Wallenburg, I and Bal, R (2018) Performance regulation in a networked healthcare system: from cosmetic to institutionalized compliance Public Administration, doi:10.1111/padm.12518.CrossRefGoogle Scholar
van der Ven, WPMM and Schut, FT (2009) Managed competition in the Netherlands: still work-in-progress. Health Economics 18, 253–255.CrossRefGoogle Scholar
Wester, J (2016) Help mee de tarieven in de zorg in kaart te brengen NRC Handelsblad, 26 August 2016, https://www.nrc.nl/nieuws/2016/08/26/onderzoekzorgkosten-a1517570 [23 July 2018].Google Scholar