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Variations in hospitalisation costs for acute myocardial infarction - a comparison across Europe

  • Oliver Tiemann

    (Department of Health Care Management, Berlin University of Technology, Germany)

Registered author(s):

    The aim of this study was to determine whether between-country variations in hospital costs are larger than within-country variations and, furthermore, to explore reasons for this variability. For this purpose, we chose the primary treatment of patients with acute myocardial infarction (AMI) as an episode of care. We obtained hospitalisation costs and reimbursement rates from 45 hospitals in nine different EU member states (i.e. Denmark, England, France, Germany, Hungary, Italy, Netherlands, Poland, and Spain) for the year 2005. To further analyse the variations in hospital costs, we employed a hierarchical random effects model based on treatment and hospital characteristics and using purchasing power parities (PPPs) as a proxy for country-specific price levels. The between-country standard error was estimated at €2473, whereas the within-country standard error was estimated at €1242. Our regression analysis showed that percutaneous coronary intervention was associated with significantly increased hospitals costs compared to other treatment strategies. We were able to distinguish between three groups of countries with different cost levels based on the number of hospitals that were able to provide these services (i.e. percutaneous transluminal coronary angioplasty (PTCA) with intracoronary stenting). Excluding Hungary, Poland, and Spain, where none of the participating hospitals were able to provide these procedures, the between-country standard error decreased to €1632, whereas the within-country standard error increased to €1416. Finally, we observed exogenous price-level effects between countries and within countries for hospitals located in urban areas. Copyright © 2008 John Wiley & Sons, Ltd.

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    File URL: http://hdl.handle.net/10.1002/hec.1322
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    Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

    Volume (Year): 17 (2008)
    Issue (Month): S1 ()
    Pages: S33-S45

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    Handle: RePEc:wly:hlthec:v:17:y:2008:i:s1:p:s33-s45
    Contact details of provider: Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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    1. Dormont, Brigitte & Milcent, Carine, 2004. "The sources of hospital cost variability," Economics Papers from University Paris Dauphine 123456789/5426, Paris Dauphine University.
    2. 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.
    3. Fernando Sánchez-Martínez & José-María Abellán-Perpiñán & Jorge-Eduardo Martínez-Pérez & Jaume Puig-Junoy, 2006. "Cost accounting and public reimbursement schemes in Spanish hospitals," Health Care Management Science, Springer, vol. 9(3), pages 225-232, August.
    4. Guillem López-Casasnovas & Marc Saez, 1999. "The impact of teaching status on average costs in Spanish hospitals," Health Economics, John Wiley & Sons, Ltd., vol. 8(7), pages 641-651.
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    6. David Epstein & Anne Mason, 2006. "Costs and prices for inpatient care in England: Mirror twins or distant cousins?," Health Care Management Science, Springer, vol. 9(3), pages 233-242, August.
    7. Pierre Moïse & Stéphane Jacobzone, 2003. "OECD Study of Cross-National Differences in the Treatment, Costs and Outcomes of Ischaemic Heart Disease," OECD Health Working Papers 3, OECD Publishing.
    8. Hausman, Jerry A, 1978. "Specification Tests in Econometrics," Econometrica, Econometric Society, vol. 46(6), pages 1251-71, November.
    9. Laura Lambie & Soeren Mattke, 2004. "Selecting Indicators for the Quality of Cardiac Care at the Health Systems Level in OECD Countries," OECD Health Technical Papers 14, OECD Publishing.
    10. Richard Grieve & Richard Nixon & Simon G. Thompson & Charles Normand, 2005. "Using multilevel models for assessing the variability of multinational resource use and cost data," Health Economics, John Wiley & Sons, Ltd., vol. 14(2), pages 185-196.
    11. Breyer, Friedrich, 1987. "The specification of a hospital cost function : A comment on the recent literature," Journal of Health Economics, Elsevier, vol. 6(2), pages 147-157, June.
    12. Edward Evans & Yuichi Imanaka & Miho Sekimoto & Tatsuro Ishizaki & Kenshi Hayashida & Haruhisa Fukuda & Eun-Hwan Oh, 2007. "Risk adjusted resource utilization for AMI patients treated in Japanese hospitals," Health Economics, John Wiley & Sons, Ltd., vol. 16(4), pages 347-359.
    13. 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.
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