The effects of DRG-based financing on hospital performance: productivity, quality and patient selection

En analyse av produktivitetsutviklingen i perioden 1999-2014 viser en samlet vekst pp omlag 25 % i denne 15-årsperioden. En stor del av denne veksten ser ut til å komme umiddelbart etter sykehusreformen i 2002, men det er også en svak vekst de siste 5-7 årene. Det har i denne perioden være en kraftig reduksjon i antall sykehus, dels grunnet nedleggelserm dels grunnet organisatoriske endringer. Mål på skalaeffektivitet er imidlertid uendret gjennom denne perioden. Samtidig viser analysene at optimal størrelse har økr, samtidig som de fleste sykehus har en faktisk størrelse som er over den estimerte optimale størrelsen. Endret kodepraksis kan påvirke produktivitetsmålene (såkalt DRG-kryp). Analyser som dekker 1999-2008 tyder på at dette har vært et neglisjerbart problem i denne perioden.

Despite widespread use little is known about the relationship between activity based financing and hospital performance. Studies of the Norwegian reform in 1997 indicate an initial boost in productivity as do similar studies of the English pay for perform ance system. In a Norwegian (and Nordic) context analysis of long term effects are however scarce as are analysis of the relationship between payment systems, quality and patient selection. We will expand on existing data from the Nordic countries to esta blish a data set describing activity and costs for the period 2000 to 2011/12. With data covering a period of 12 years we will be able to provide measures of long term productivity growth in the Norwegian hospital sector, and relate this to the extent of and fluctuations in the degree of activity based financing. Specifically we will also look for associations between activity based financing and quality as well as between activity based financing and patient selection and DRG-creep. The project is linke d into an existing EU FP7 project in which the project group has the responsibility for one WP. It will also draw substantially on an international advisory group consisting of researchers from countries with similar systems - i.e. UK, Spain, Portugal as well as the other Nordic countries. In the analysis Finland, Sweden and Denmark will act as "control groups" to the Norwegian hospitals. The project is ambitions in the use of methodology - productivity measures will be obtained both by using non-parametr ic (DEA) and parametric methods (SFA). Analysis of associations between hospital payment and productivity/quality/selection will utilize multilevel regression techniques. The project will employ two PhD candidates as well as senior personnel.