title: A roadmap for comparing readmission policies with application to Denmark, England, Germany and the United States.
abstract: Hospital readmissions receive increasing interest from policy makers because reducing unnecessary readmissions has the potential to simultaneously improve quality and save costs. This paper reviews readmission policies in Denmark, England, Germany and the United States (Medicare system). The suggested roadmap enables researchers and policy makers to systematically compare and analyse readmission policies. We find considerable differences across countries. In Germany, the readmission policy aims to avoid unintended consequences of the introduction of DRG-based payment; it focuses on readmissions of individual patients and hospitals receive only one DRG-based payment for both the initial and the re-admission. In Denmark, England and the US readmission policies aim at quality improvement and focus on readmission rates. In Denmark, readmission rates are publicly reported but payments are not adjusted in relation to readmissions. In England and the US, financial incentives penalise hospitals with readmission rates above a certain benchmark. In England, this benchmark is defined through local clinical review, while it is based on the risk-adjusted national average in the US. At present, not enough evidence exists to give recommendations on the optimal design of readmission policies. The roadmap can be a tool for systematically assessing how elements of other countries' readmission policies can potentially be adopted to improve national policies.
authors.affiliation: Manchester Centre for Health Economics, University of Manchester, UK; COHERE - Centre of Health Economics Research, Department of Business and Economics, University of Southern Denmark, Denmark.
authors.forename: Søren Rud
authors.initials: SR
authors.lastname: Kristensen
authors.affiliation: COHERE - Centre of Health Economics Research, Department of Business and Economics, University of Southern Denmark, Denmark. Electronic address: mbe@sam.sdu.dk.
authors.forename: Mickael
authors.initials: M
authors.lastname: Bech
authors.affiliation: Department of Health Care Management, Berlin University of Technology, Germany; European Observatory on Health Systems and Policies, Brussels, Belgium.
authors.forename: Wilm
authors.initials: W
authors.lastname: Quentin
mesh_terms: D004469:Economics, Hospital; D005060:Europe; D006291:Health Policy; D007349:Insurance, Health, Reimbursement; D010359:Patient Readmission; D014481:United States
keywords: Avoidable readmissions; Hospital reimbursement; Provider payment; Readmission policies; Readmission rates