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Effect of a law limiting upcoding on hospitals' admissions: Evidence from Italy

Author

Listed:
  • Giorgio Vittadini
  • Paolo Berta

  • Gianmaria Martini

  • Giuditta Callea

Abstract

Policy makers have made several attempts to limit hospitals upcoding. We investigate the impact on discharges with and without complications of a law introducing a minimum length of stay to discharges with complications. We implement a DID econometric model to assess the impact of the law and a logistic multilevel model to estimate whether hospitals reacted strategically to it by varying the patients' length of stay. We show that the policy has been effective in limiting upcoding, since the number of discharges with complications is significantly lower in 2008. We also show that hospitals have reacted strategically to the law by modifying the distribution of discharges' length of stay in DRGs with complications, in order to continue practicing upcoding. Furthermore, we provide evidence that upcoding is greater in private for-profit hospitals, that have been more affected by the law.

Suggested Citation

  • Giorgio Vittadini & Paolo Berta & Gianmaria Martini & Giuditta Callea, 2010. "Effect of a law limiting upcoding on hospitals' admissions: Evidence from Italy," Working Papers 1005, Department of Management, Information and Production Engineering, University of Bergamo.
    • Handle: RePEc:brh:wpaper:1005
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    File URL: http://hdl.handle.net/10446/669
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    2. Paolo Berta & Gianmaria Martini & Francesco Moscone & Giorgio Vittadini, 2016. "The association between asymmetric information, hospital competition and quality of healthcare: evidence from Italy," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 179(4), pages 907-926, October.
    3. Pedro Barros & Gisele Braun, 2017. "Upcoding in a National Health Service: the evidence from Portugal," Health Economics, John Wiley & Sons, Ltd., vol. 26(5), pages 600-618, May.
    4. Paolo Berta & Gianmaria Martini & Massimiliano Piacenza & Gilberto Turati, 2020. "The strange case of less C‐sections: Hospital ownership, market concentration, and DRG‐tariff regulation," Health Economics, John Wiley & Sons, Ltd., vol. 29(S1), pages 30-46, October.

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    Keywords

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    JEL classification:

    • C51 - Mathematical and Quantitative Methods - - Econometric Modeling - - - Model Construction and Estimation
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • L33 - Industrial Organization - - Nonprofit Organizations and Public Enterprise - - - Comparison of Public and Private Enterprise and Nonprofit Institutions; Privatization; Contracting Out

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