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Patient Classification Systems And Hospital Costs Of Care For Knee Replacement In 10 European Countries

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  • Francesc Cots
  • Pietro Chiarello
  • Xavier Salvador
  • Xavier Castells
  • on behalf of the EuroDRG group

Abstract

Knee replacement is a common surgical procedure performed to relieve pain and disability from degenerative osteoarthritis. This study evaluates the ability of ten European diagnosis‐related group (DRG) systems to explain variations in costs or in length of stay for knee replacements. We assessed three different models in predicting variation of cost and length of stay. The first model, MD, included only DRG groups as explanatory variables; the second, MP, used a set of patient‐level variables; and the third, MF, included all variables from both MD and MP. The total number of DRGs used to group knee replacement is low, ranging from two to six. All DRG systems except one differentiate between primary knee replacement and revision surgery. Considerable differences exist in the rate of revision surgery. There is also high variation in mean cost (from € 3809 to € 8158) and in mean length of stay (LoS) (from 4.2 to 13.6 days). The explanatory power of DRGs varies from 21.5 to 72.5% with values of around 40% in most countries of the study. Findings suggest that DRG systems could be enhanced either by the inclusion of patient‐level variables, by the use of measures of clinical outcome or by improving cost and administrative information. Copyright © 2012 John Wiley & Sons, Ltd.

Suggested Citation

  • Francesc Cots & Pietro Chiarello & Xavier Salvador & Xavier Castells & on behalf of the EuroDRG group, 2012. "Patient Classification Systems And Hospital Costs Of Care For Knee Replacement In 10 European Countries," Health Economics, John Wiley & Sons, Ltd., vol. 21(S2), pages 116-128, August.
    • Handle: RePEc:wly:hlthec:v:21:y:2012:i:s2:p:116-128
    DOI: 10.1002/hec.2838
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    References listed on IDEAS

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    1. Andrew Street & Conrad Kobel & Thomas Renaud & Josselin Thuilliez & ON BEHALF OF THE EURODRG GROUP, 2012. "How Well Do Diagnosis‐Related Groups Explain Variations In Costs Or Length Of Stay Among Patients And Across Hospitals? Methods For Analysing Routine Patient Data," Health Economics, John Wiley & Sons, Ltd., vol. 21(S2), pages 6-18, August.
    2. Andrew Street & Conrad Kobel & Thomas Renaud & Josselin Thuilliez & ON BEHALF OF THE EURODRG GROUP, 2012. "How Well Do Diagnosis‐Related Groups Explain Variations In Costs Or Length Of Stay Among Patients And Across Hospitals? Methods For Analysing Routine Patient Data," Health Economics, John Wiley & Sons, Ltd., vol. 21(S2), pages 6-18, August.
    3. Conrad Kobel & Josselin Thuilliez & Martine Bellanger & Karl-Peter Pfeiffer, 2011. "DRG systems and similar patient classification systems in Europe," Université Paris1 Panthéon-Sorbonne (Post-Print and Working Papers) halshs-00643049, HAL.
    4. Mark McClellan, 1997. "Hospital Reimbursement Incentives: An Empirical Analysis," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 6(1), pages 91-128, March.
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    1. 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.
    2. Unto Häkkinen & Gunnar Rosenqvist & Tor Iversen & Clas Rehnberg & Timo T. Seppälä & on behalf of the EuroHOPE study group, 2015. "Outcome, Use of Resources and Their Relationship in the Treatment of AMI, Stroke and Hip Fracture at European Hospitals," Health Economics, John Wiley & Sons, Ltd., vol. 24(S2), pages 116-139, December.

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