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Health service costs in Europe: cost and reimbursement of primary hip replacement in nine countries


  • Tom Stargardt


This paper assesses variations in the cost of primary hip replacement between and within nine member states of the European Union (EU). It also compares the cost of service with public‐payer reimbursements. To do so, data on cost and reimbursement were surveyed at the micro‐level in 42 hospitals in Denmark, England, France, Germany, Hungary, Italy, The Netherlands, Poland, and Spain. The total cost of treatment ranged from €1290 (Hungary) to €8739 (The Netherlands), with a mean cost of €5043 (STD±€2071). The main cost drivers were found to be implants (34% of total cost on average) and ward costs (20.9% of total cost on average). A one‐way random effects analysis of variance model indicated that 74.0% of variation was between and only 26% of variation was within countries. In a two‐level random‐intercept regression model, purchasing‐power parities explained 79.4% of the explainable between‐country variation, while the percentage of uncemented implants used and the number of beds explained 12.1 and 1.6% of explainable within‐country variation, respectively. The large differences in cost and reimbursement between Poland, Hungary, and the other EU member states shows that primary total hip replacement is a highly relevant case for cross‐border care. Copyright © 2008 John Wiley & Sons, Ltd.

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  • Tom Stargardt, 2008. "Health service costs in Europe: cost and reimbursement of primary hip replacement in nine countries," Health Economics, John Wiley & Sons, Ltd., vol. 17(S1), pages 9-20, January.
  • Handle: RePEc:wly:hlthec:v:17:y:2008:i:s1:p:s9-s20
    DOI: 10.1002/hec.1328

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    References listed on IDEAS

    1. Adam, Taghreed & Evans, David B., 2006. "Determinants of variation in the cost of inpatient stays versus outpatient visits in hospitals: A multi-country analysis," Social Science & Medicine, Elsevier, vol. 63(7), pages 1700-1710, October.
    2. Luigi Siciliani & Jeremy Hurst, 2003. "Explaining Waiting Times Variations for Elective Surgery Across OECD Countries," OECD Health Working Papers 7, OECD Publishing.
    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. 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.
    5. Adam Kozierkiewicz & Maciej Stamirski & Waldemar Stylo & Wojciech Trąbka, 2006. "The definition of prices for inpatient care in Poland in the absence of cost data," Health Care Management Science, Springer, vol. 9(3), pages 281-286, August.
    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.
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    Cited by:

    1. Laudicella, Mauro & Siciliani, Luigi & Cookson, Richard, 2012. "Waiting times and socioeconomic status: Evidence from England," Social Science & Medicine, Elsevier, vol. 74(9), pages 1331-1341.
    2. Majo, M.C., 2010. "A microeconometric analysis of health care utilization in Europe," Other publications TiSEM 1cf5fd2f-8146-4ef8-8eb5-e, Tilburg University, School of Economics and Management.
    3. Eberhard Feess & Helge Müller & Ansgar Wohlschlegel, 2019. "Reimbursement schemes for hospitals: the impact of case and firm characteristics," Applied Economics, Taylor & Francis Journals, vol. 51(15), pages 1647-1665, March.
    4. Majo, Maria Cristina & van Soest, Arthur, 2012. "Income and health care utilization among the 50+ in Europe and the US," Applied Econometrics, Publishing House "SINERGIA PRESS", vol. 28(4), pages 3-22.
    5. Melberg, Hans Olav, 2011. "Some problems with international comparisons of health spending – and a suggestion about how to quantify the size of the problems," HERO Online Working Paper Series 2011:4, University of Oslo, Health Economics Research Programme.
    6. 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.
    7. 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.
    8. Reinhard Busse & on behalf of the EuroDRG group, 2012. "DO DIAGNOSIS‐RELATED GROUPS EXPLAIN VARIATIONS IN HOSPITAL COSTS AND LENGTH OF STAY? – ANALYSES FROM THE EURODRG PROJECT FOR 10 EPISODES OF CARE ACROSS 10 EuroPEAN COUNTRIES," Health Economics, John Wiley & Sons, Ltd., vol. 21(S2), pages 1-5, August.
    9. Glinos, Irene A. & Baeten, Rita & Maarse, Hans, 2010. "Purchasing health services abroad: Practices of cross-border contracting and patient mobility in six European countries," Health Policy, Elsevier, vol. 95(2-3), pages 103-112, May.

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