IDEAS home Printed from https://ideas.repec.org/a/spr/eujhec/v24y2023i4d10.1007_s10198-022-01496-0.html
   My bibliography  Save this article

Sex differences in care complexity and cost of cardiac-related procedures as a basis for improving hospital payments systems

Author

Listed:
  • Shuli Brammli-Greenberg

    (The Hebrew University of Jerusalem
    Myers-JDC-Brookdale Institute)

  • Sharvit Fialco

    (Myers-JDC-Brookdale Institute)

  • Neria Shtauber

    (Ministry of Health)

  • Yoram Weiss

    (Hadassah Medical Organization)

Abstract

In this study, we estimate sex differences in care complexity and cost of cardiac-related procedures in order to demonstrate the importance of sex as a risk adjuster in a hospital payment system. We use individual visit-level data for all adult Israelis who underwent either heart valve surgery (HVS) or coronary artery bypass graft surgery (CABG) during the period 2014–2018 in publicly funded hospitals. We find that women undergoing a cardiac-related procedure are more likely to die during hospitalization, they have longer hospital stays, and overall, they are more likely to be care-complex than men. Furthermore, the cost of the surgery itself is higher for women than for men in the case of HVS (though not CABG), and the cost of the post-operative hospital stay is higher in the case of CABG (though not HVS). It is concluded that sex differences should be considered in the calculation of payment for cardiac-related procedures in order to reduce incentives for selection and reduce unwarranted variation in cardiac-care utilization and medical practice.

Suggested Citation

  • Shuli Brammli-Greenberg & Sharvit Fialco & Neria Shtauber & Yoram Weiss, 2023. "Sex differences in care complexity and cost of cardiac-related procedures as a basis for improving hospital payments systems," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(4), pages 539-556, June.
    • Handle: RePEc:spr:eujhec:v:24:y:2023:i:4:d:10.1007_s10198-022-01496-0
    DOI: 10.1007/s10198-022-01496-0
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s10198-022-01496-0
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.
    File URL: https://libkey.io/10.1007/s10198-022-01496-0?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Anne Case & Christina Paxson, 2005. "Sex differences in morbidity and mortality," Demography, Springer;Population Association of America (PAA), vol. 42(2), pages 189-214, May.
    2. Kathryn Antioch & Michael Walsh, 2004. "The risk-adjusted vision beyond casemix (DRG) funding in Australia," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 5(2), pages 115-115, May.
    3. Kathryn Antioch & Michael Walsh, 2004. "The risk-adjusted vision beyond casemix (DRG) funding in Australia," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 5(2), pages 95-109, May.
    4. Ellis, Randall P. & McGuire, Thomas G., 1996. "Hospital response to prospective payment: Moral hazard, selection, and practice-style effects," Journal of Health Economics, Elsevier, vol. 15(3), pages 257-277, June.
    5. Kathryn Antioch & Randall Ellis & Steve Gillett & Daniel Borovnicar & Ric Marshall, 2007. "Risk adjustment policy options for casemix funding: international lessons in financing reform," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 8(3), pages 195-212, September.
    6. Brammli-Greenberg, Shuli & Waitzberg, Ruth & Perman, Vadim & Gamzu, Ronni, 2016. "Why and how did Israel adopt activity-based hospital payment? The Procedure-Related Group incremental reform," Health Policy, Elsevier, vol. 120(10), pages 1171-1176.
    7. Philippe K. Widmer & Maria Trottmann & Peter Zweifel, 2018. "Choice of reserve capacity by hospitals: a problem for prospective payment," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(5), pages 663-673, June.
    8. Martinussen, Pã…L E. & Hagen, Terje P., 2009. "Reimbursement systems, organisational forms and patient selection: Evidence from day surgery in Norway," Health Economics, Policy and Law, Cambridge University Press, vol. 4(2), pages 139-158, April.
    9. James Gaughan & Conrad Kobel, 2014. "Coronary artery bypass grafts and diagnosis related groups: patient classification and hospital reimbursement in 10 European countries," Health Economics Review, Springer, vol. 4(1), pages 1-13, December.
    10. Ellis, Randall P. & McGuire, Thomas G., 1986. "Provider behavior under prospective reimbursement : Cost sharing and supply," Journal of Health Economics, Elsevier, vol. 5(2), pages 129-151, June.
    11. Thomas G. McGuire & Sonja Schillo & Richard C. Kleef, 2021. "Very high and low residual spenders in private health insurance markets: Germany, The Netherlands and the U.S. Marketplaces," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(1), pages 35-50, February.
    12. Bergquist, Savannah L. & Layton, Timothy J. & McGuire, Thomas G. & Rose, Sherri, 2019. "Data transformations to improve the performance of health plan payment methods," Journal of Health Economics, Elsevier, vol. 66(C), pages 195-207.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Guilhermina Rego & Rui Nunes & José Costa, 2010. "The challenge of corporatisation: the experience of Portuguese public hospitals," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(4), pages 367-381, August.
    2. Fengrong Liu & Jiayu Chen & Chaozhu Li & Fenghui Xu, 2023. "Cost Sharing and Cost Shifting Mechanisms under a per Diem Payment System in a County of China," IJERPH, MDPI, vol. 20(3), pages 1-12, January.
    3. Cots, Francesc & Elvira, David & Castells, Xavier & Dalmau, Eulalia, 2000. "Medicare's DRG-weights in a European environment: the Spanish experience," Health Policy, Elsevier, vol. 51(1), pages 31-47, February.
    4. Sonja Ossig & Eberhard Feess, 2004. "The impact of liability for malpractice on the optimal reimbursement schemes for health services," Econometric Society 2004 Far Eastern Meetings 396, Econometric Society.
    5. Li‐Lin Liang, 2015. "Do Diagnosis‐Related Group‐Based Payments Incentivise Hospitals to Adjust Output Mix?," Health Economics, John Wiley & Sons, Ltd., vol. 24(4), pages 454-469, April.
    6. Jurgita Januleviciute & Jan Erik Askildsen & Oddvar Kaarboe & Luigi Siciliani & Matt Sutton, 2016. "How do Hospitals Respond to Price Changes? Evidence from Norway," Health Economics, John Wiley & Sons, Ltd., vol. 25(5), pages 620-636, May.
    7. Matthias Bäuml & Christian Kümpel, 2021. "Hospital responses to the refinement of reimbursements by treatment intensity in DRG systems," Health Economics, John Wiley & Sons, Ltd., vol. 30(3), pages 585-602, March.
    8. Clara Pott & Tom Stargardt & Udo Schneider & Simon Frey, 2021. "Do discontinuities in marginal reimbursement affect inpatient psychiatric care in Germany?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(1), pages 101-114, February.
    9. Jonas Schreyögg & Oliver Tiemann & Reinhard Busse, 2006. "Cost accounting to determine prices: How well do prices reflect costs in the German DRG-system?," Health Care Management Science, Springer, vol. 9(3), pages 269-279, August.
    10. Jason Sutherland & R. T. Crump & Nadya Repin & Erik Hellsten, 2013. "Paying for Hospital Services: A Hard Look at the Options," C.D. Howe Institute Commentary, C.D. Howe Institute, issue 378, April.
    11. Feess, Eberhard & Ossig, Sonja, 2007. "Reimbursement schemes for hospitals, malpractice liability, and intrinsic motivation," International Review of Law and Economics, Elsevier, vol. 27(4), pages 423-441, December.
    12. Melberg, Hans Olav & Pedersen, Kine, 2015. "Do changes in reimbursement fees affect hospital prioritization?," HERO Online Working Paper Series 2015:1, University of Oslo, Health Economics Research Programme.
    13. Hanjo M. Koehler, 2006. "Yardstick Competition when Quality is Endogenous: The Case of Hospital Regulation," Working Papers 013, Bavarian Graduate Program in Economics (BGPE).
    14. Kathryn Antioch & Randall Ellis & Steve Gillett & Daniel Borovnicar & Ric Marshall, 2007. "Risk adjustment policy options for casemix funding: international lessons in financing reform," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 8(3), pages 195-212, September.
    15. Jonas Schreyögg & Tom Stargardt & Oliver Tiemann & Reinhard Busse, 2006. "Methods to determine reimbursement rates for diagnosis related groups (DRG): A comparison of nine European countries," Health Care Management Science, Springer, vol. 9(3), pages 215-223, August.
    16. Jason Sutherland & Jeremy Hamm & Jeff Hatcher, 2010. "Adjusting case mix payment amounts for inaccurately reported comorbidity data," Health Care Management Science, Springer, vol. 13(1), pages 65-73, March.
    17. Tsuyoshi Takahara, 2016. "Patient dumping, outlier payments, and optimal healthcare payment policy under asymmetric information," Health Economics Review, Springer, vol. 6(1), pages 1-11, December.
    18. Karen Eggleston & Randall P. Ellis & Mingshan Lu, 2007. "Prevention and Dynamic Risk Adjustment," Boston University - Department of Economics - Working Papers Series WP2007-023, Boston University - Department of Economics.
    19. Philip Hochuli, 2020. "Losing body weight for money: How provider‐side financial incentives cause weight loss in Swiss low‐birth‐weight newborns," Health Economics, John Wiley & Sons, Ltd., vol. 29(4), pages 406-418, April.
    20. Chiara Canta, 2021. "Efficiency, access, and the mixed delivery of health care services," Journal of Public Economic Theory, Association for Public Economic Theory, vol. 23(3), pages 510-533, June.

    More about this item

    Keywords

    Hospital payment; Risk-adjustment; Sex; Cardiac-related procedures;
    All these keywords.

    JEL classification:

    • H21 - Public Economics - - Taxation, Subsidies, and Revenue - - - Efficiency; Optimal Taxation
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • J16 - Labor and Demographic Economics - - Demographic Economics - - - Economics of Gender; Non-labor Discrimination

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:eujhec:v:24:y:2023:i:4:d:10.1007_s10198-022-01496-0. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.