title: Knee replacement and Diagnosis-Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries.
abstract: OBJECTIVE
  Researchers from 11 countries (Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) compared how their Diagnosis-Related Group (DRG) systems deal with knee replacement cases. The study aims to assist knee surgeons and national authorities to optimize the grouping algorithm of their DRG systems.
  
  
  METHODS
  National or regional databases were used to identify hospital cases treated with a procedure of knee replacement. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that together comprised at least 97 % of cases. Five standardized case scenarios were defined and quasi-prices according to national DRG-based hospital payment systems ascertained.
  
  
  RESULTS
  Grouping algorithms for knee replacement vary widely across countries: they classify cases according to different variables (between one and five classification variables) into diverging numbers of DRGs (between one and five DRGs). Even the most expensive DRGs generally have a cost index below 2.00, implying that grouping algorithms do not adequately account for cases that are more than twice as costly as the index DRG. Quasi-prices for the most complex case vary between euro 4,920 in Estonia and euro 14,081 in Spain.
  
  
  CONCLUSIONS
  Most European DRG systems were observed to insufficiently consider the most important determinants of resource consumption. Several countries' DRG system might be improved through the introduction of classification variables for revision of knee replacement or for the presence of complications or comorbidities. Ultimately, this would contribute to assuring adequate performance comparisons and fair hospital reimbursement on the basis of DRGs.
authors: Institute for Medical Technology Assessment, Erasmus Universiteit Rotterdam, P. O. Box 1738, 3000 DR, Rotterdam, The Netherlands, tan@bmg.eur.nl.
authors: Siok Swan
authors: SS
authors: Tan
authors: Pietro
authors: P
authors: Chiarello
authors: Wilm
authors: W
authors: Quentin
mesh_terms: D000465:Algorithms; D019645:Arthroplasty, Replacement, Knee / Q000191:economics*; D016208:Databases, Factual; D003953:Diagnosis-Related Groups; D005060:Europe; D006801:Humans; D007592:Joint Diseases / Q000145:classification / Q000601:surgery*; D012051:Reimbursement Mechanisms; D012189:Retrospective Studies