Payment systems for hospital stays with high variability

Cooperation project with KCE – Belgian Health Care Knowledge Centre and Cliniques Universitaires Saint-Luc

This project is funded by the Belgian government and is carried out in collaboration with the Belgian Health Care Knowledge Centre (https://kce.fgov.be/) and the Cliniques Universitaires Saint-Luc (http://www.saintluc.be/). Hospitals in most high income countries are paid on the basis of Diagnosis Related Groups (DRGs). However, the treatment costs of some patient groups are difficult to predict. Consequently, it is difficult to include these patient groups in DRG-based hospital payment. The project aims to understand how hospitals are paid for the treatment of these patients in 5-6 high income countries. The results of the project will inform discussions on a hospital payment reform in Belgium. The project will include a review of scientific and grey literature and a survey of experts in selected countries in order to address the following research questions:
(1) Which patient groups are excluded and how are hospitals paid for these patients? How are these groups identified?
(2) Which services and products are reimbursed separately in addition to the core DRG-system and how are they identified?
(3) What mechanisms exist to take outliers into account? And how are outliers defined and paid for?

KCE REPORT 302Cs, SHORT REPORT: PAYMENT METHODS FOR HOSPITAL STAYS WITH A LARGE VARIABILITY IN THE CARE PROCESS [1]