Funding intensive care -- approaches in systems using diagnosis-related groups

by Stefanie Ettelt, Ellen Nolte

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Abstract

This report reviews approaches to funding intensive care in health systems that use activity-based payment mechanisms based on diagnosis-related groups (DRGs) to reimburse hospital care in Australia (Victoria), Denmark, France, Germany, Italy, Spain, Sweden and the United States (Medicare). The report aims to inform the current debate about options for funding intensive care services for adults, children and newborns in England. Mechanisms of funding intensive care services tend to fall into three broad categories: (1) those that fund intensive care through DRGs as part of one episode of hospital care only (US Medicare, Germany, selected regions in Sweden and Italy; (2) those that use DRGs in combination with co-payments (Victoria, France); and (3) those that exclude intensive care from DRG funding and use an alternative form of payment, for example global budgets (Spain) or per diems (South Australia). The review suggests that there is no obvious example of “best practice” or dominant approach used by a majority of systems. Each approach has advantages and disadvantages, particularly in relation to the financial risk involved in providing intensive care. While the risk of underfunding intensive care may be highest in systems that apply DRGs to the entire episode of hospital care, including intensive care, concerns about potential underfunding were voiced in all systems reviewed here. Arrangements for additional funding in the form of co-payments or surcharges may reduce the risk of underfunding. However, these approaches also face the difficulty of determining the appropriate level of (additional) payment and balancing the incentive effect arising from higher payment.

Table of Contents

  • Chapter One

    Overview

  • Chapter Two

    Australia

  • Chapter Three

    Denmark

  • Chapter Four

    France

  • Chapter Five

    Germany

  • Chapter Six

    Italy

  • Chapter Seven

    Spain

  • Chapter Eight

    Sweden

  • Chapter Eight

    United States - Medicare

  • Chapter Eight

    DRG payments for newborn intensive care: evidence and issues from a US perspective

  • Appendix A

    Questionnaire

Research conducted by

The research in this report was conducted by RAND Europe and prepared for the Department of Health (UK) within the PRP project “An ‘On-call’ Facility for International Healthcare Comparisons”.

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