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The impact of hospital-acquired infections on the patient-level reimbursement-cost relationship in a DRG-based hospital payment system

Author

Listed:
  • Klaus Kaier

    (Faculty of Medicine and Medical Center – University of Freiburg)

  • Martin Wolkewitz

    (Faculty of Medicine and Medical Center – University of Freiburg)

  • Philip Hehn

    (Faculty of Medicine and Medical Center – University of Freiburg)

  • Nico T. Mutters

    (Medical Center – University of Freiburg)

  • Thomas Heister

    (Faculty of Medicine and Medical Center – University of Freiburg)

Abstract

Hospital-acquired infections (HAIs) are a common complication in inpatient care. We investigate the incentives to prevent HAIs under the German DRG-based reimbursement system. We analyze the relationship between resource use and reimbursements for HAI in 188,731 patient records from the University Medical Center Freiburg (2011–2014), comparing cases to appropriate non-HAI controls. Resource use is approximated using national standardized costing system data. Reimbursements are the actual payments to hospitals under the G-DRG system. Timing of HAI exposure, cost-clustering within main diagnoses and risk-adjustment are considered. The reimbursement-cost difference of HAI patients is negative (approximately − €4000). While controls on average also have a negative reimbursement-cost difference (approximately − €2000), HAI significantly increase this difference after controlling for confounding and timing of infection (− 1500, p

Suggested Citation

  • Klaus Kaier & Martin Wolkewitz & Philip Hehn & Nico T. Mutters & Thomas Heister, 2020. "The impact of hospital-acquired infections on the patient-level reimbursement-cost relationship in a DRG-based hospital payment system," International Journal of Health Economics and Management, Springer, vol. 20(1), pages 1-11, March.
    • Handle: RePEc:kap:ijhcfe:v:20:y:2020:i:1:d:10.1007_s10754-019-09267-w
    DOI: 10.1007/s10754-019-09267-w
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    References listed on IDEAS

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    1. Thomas Heister & Christian Hagist & Klaus Kaier, 2017. "Resistance Elasticity of Antibiotic Demand in Intensive Care," Health Economics, John Wiley & Sons, Ltd., vol. 26(7), pages 892-909, July.
    2. Ansgar Resch & Michael Wilke & Christian Fink, 2009. "The cost of resistance: incremental cost of methicillin-resistant Staphylococcus aureus (MRSA) in German hospitals," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 10(3), pages 287-297, July.
    3. Søren Rud Kristensen, 2017. "Financial Penalties for Performance in Health Care," Health Economics, John Wiley & Sons, Ltd., vol. 26(2), pages 143-148, February.
    4. Matthias Vogl, 2012. "Assessing DRG cost accounting with respect to resource allocation and tariff calculation: the case of Germany," Health Economics Review, Springer, vol. 2(1), pages 1-12, December.
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    More about this item

    Keywords

    HAI; G-DRG; Incentives; Reimbursement; Cost;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General

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