title: Effects of DRG-based hospital payment in Poland on treatment of patients with stroke.
abstract: A prospective payment system based on Diagnosis Related Groups (DRGs) presents strong financial incentives to healthcare providers. These incentives may have intended as well as unintended consequences for the healthcare system. In this paper we use administrative data on stroke admissions to Polish hospitals in order to demonstrate the response of hospitals to the incentives embedded in the design of stroke-related groups in Poland. The design was intended to motivate hospitals for the development of specialized stroke units by paying significantly higher tariffs for treatment of patients in these units. As a result, an extensive network of stroke units has emerged. However, as it is shown in the paper, there is no evidence that outcomes in hospitals with stroke units are significantly different from outcomes in hospitals without stroke units. It is also demonstrated that the reliance on the length of stay as a major grouping variable provides incentives for regrouping patients into more expensive groups by extending their length of stay in stroke units. The results of the study are limited by the incompleteness of the casemix data. There is a need to develop information and audit systems which would further inform a revision of the DRG system aimed to reduce the risk of regrouping and up-coding.
authors.affiliation: Faculty of Economics and Sociology, University of Lodz, Rewolucji 1905 r. 41, 90-214 Lodz, Poland. Electronic address: victor.bystrov@gmail.com.
authors.forename: Victor
authors.initials: V
authors.lastname: Bystrov
authors.affiliation: Faculty of Economics and Sociology, University of Lodz, Rewolucji 1905 r. 41, 90-214 Lodz, Poland. Electronic address: emfans@uni.lodz.pl.
authors.forename: Anna
authors.initials: A
authors.lastname: Staszewska-Bystrova
authors.affiliation: National Health Fund, Poland. Electronic address: Daniel.Rutkowski@nfz.gov.pl.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rutkowski
authors.affiliation: Department of Pharmacoeconomics, Medical University of Warsaw, Poland. Electronic address: tomasz.hermanowski@wum.edu.pl.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Hermanowski
mesh_terms: D003953:Diagnosis-Related Groups / Q000191:economics* / Q000458:organization & administration; D004469:Economics, Hospital; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D011044:Poland; D011787:Quality of Health Care / Q000191:economics / Q000458:organization & administration; D012051:Reimbursement Mechanisms / Q000191:economics / Q000458:organization & administration; D012052:Reimbursement, Incentive / Q000191:economics / Q000458:organization & administration; D020521:Stroke / Q000628:therapy*; D016896:Treatment Outcome
keywords: Diagnosis Related Groups; Hospital payment; Length of stay; Monitoring of outcomes; Stroke