IDEAS home Printed from
   My bibliography  Save this article

A micro‐costing approach to estimating hospital costs for appendectomy in a Cross‐European context


  • Jonas Schreyögg


This paper aims (a) to determine whether variations in the hospital costs of appendectomy in EU member states are larger within individual countries or between different countries and (b) to explore causes for variations in costs between hospitals and countries. To do so, hospitalisation costs and reimbursement rates for appendectomy were obtained from 54 hospitals in nine European member states based on 1786 cases using a standardised methodology. Regression analysis was performed using hospital characteristics, treatment characteristics, and purchasing power parities (PPP) as explanatory variables in a multilevel framework. The within‐country standard error was estimated to €294 (27%), whereas the between‐country standard error was €796 (73%). Excluding hospitals in Spain, Hungary, and Poland, which had significantly lower costs than hospitals in the other countries in our analysis, the within‐country standard error was €331 (57%) and the between‐country standard error dropped to €248 (43%). Regression results show that the treatment decision for open surgery was associated with significantly lower costs, whereas a greater number of beds and a higher staff per bed ratio were associated with significantly higher costs. PPP explained a major part of the between‐country variance. Copyright © 2008 John Wiley & Sons, Ltd.

Suggested Citation

  • Jonas Schreyögg, 2008. "A micro‐costing approach to estimating hospital costs for appendectomy in a Cross‐European context," Health Economics, John Wiley & Sons, Ltd., vol. 17(S1), pages 59-69, January.
  • Handle: RePEc:wly:hlthec:v:17:y:2008:i:s1:p:s59-s69
    DOI: 10.1002/hec.1323

    Download full text from publisher

    File URL:
    Download Restriction: no

    References listed on IDEAS

    1. 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.
    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. Hausman, Jerry, 2015. "Specification tests in econometrics," Applied Econometrics, Publishing House "SINERGIA PRESS", vol. 38(2), pages 112-134.
    4. Evans III, John H. & Hwang, Yuhchang & Nagarajan, Nandu J., 2001. "Management control and hospital cost reduction: additional evidence," Journal of Accounting and Public Policy, Elsevier, vol. 20(1), pages 73-88.
    5. Sarah Wordsworth & Anne Ludbrook, 2005. "Comparing costing results in across country economic evaluations: the use of technology specific purchasing power parities," Health Economics, John Wiley & Sons, Ltd., vol. 14(1), pages 93-99, January.
    6. 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, February.
    7. 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, April.
    8. 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.
    Full references (including those not matched with items on IDEAS)


    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.

    Cited by:

    1. Olfa Rejeb & Claire Pilet & Sabri Hamana & Xiaolan Xie & Thierry Durand & Saber Aloui & Anne Doly & Pierre Biron & Lionel Perrier & Vincent Augusto, 2018. "Performance and cost evaluation of health information systems using micro-costing and discrete-event simulation," Health Care Management Science, Springer, vol. 21(2), pages 204-223, June.
    2. Jonas Schreyögg & Oliver Tiemann & Tom Stargardt & Reinhard Busse, 2008. "Cross‐country comparisons of costs: the use of episode‐specific transitive purchasing power parities with standardised cost categories," Health Economics, John Wiley & Sons, Ltd., vol. 17(S1), pages 95-103, January.
    3. Reinhard Busse & Jonas Schreyögg & Peter C. Smith, 2008. "Variability in healthcare treatment costs amongst nine EU countries – results from the HealthBASKET project," Health Economics, John Wiley & Sons, Ltd., vol. 17(S1), pages 1-8, January.
    4. Johannessen, Karl Arne & Kittelsen, Sverre A.C. & Hagen, Terje P., 2017. "Assessing physician productivity following Norwegian hospital reform: A panel and data envelopment analysis," Social Science & Medicine, Elsevier, vol. 175(C), pages 117-126.
    5. Laura Haas & Tom Stargardt & Jonas Schreyoegg, 2012. "Cost-effectiveness of open versus laparoscopic appendectomy: a multilevel approach with propensity score matching," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(5), pages 549-560, October.

    More about this item


    Access and download statistics


    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:wly:hlthec:v:17:y:2008:i:s1:p:s59-s69. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Wiley Content Delivery). General contact details of provider: .

    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 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.

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

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.