1,721,003 research outputs found
Efficiency and opportunistic behaviour induced by prospective payment system in the hospital sector
Get PDFConversations with the editor: optimizing patient pathways through the activation of an aortic valve outpatient day service
Get PDFThroughout a medical technology's life cycle, stakeholders may play different roles of varying significance. National agencies (eg, the US Food and Drug Administration, European Union Competent Authorities) are the key actors in regulatory approval (eg, US Food and Drug Administration approval, CE Mark), whereas national/regional policy makers determine coverage and reimbursement of innovative technologies. For mature, already adopted technologies, the hospital level has a pivotal role in the rational and appropriate use of resources. Dr. Sergio Berti has implemented a pilot project for TAVI patient pathway optimization at the Ospedale del Cuore G. Pasquinucci–G. Monasterio Foundation, Massa, Italy, based on the activation of a dedicated day service ambulatory program to perform advance imaging tests and examinations. This project has resulted in facilitating patient referrals to the most appropriate therapeutic option, faster patient recovery due to earlier patient mobilization and shorter length of stay, and better capacity to plan operating room activity. This experience shows how organizational innovations might help hospitals improve patient care and gain efficiency
The impact of uncoding, cream skimming and readmissions on hospitals' efficiency: the case of Lombardy
Get PDFThis paper investigates the efficiency of Italian hospitals during the period 1998–2007 and consider the impact of some DRG distortionslike uocoding, cream skimming and readmission. We apply both a stochastic frontier approach and a multilevel model. We show that readmissions are the most relevant distortion. Moreover, cream skim-ming has a negative impact for public and private hospitals and up-coding has a clear positive but little impact only for public hospitals. These results imply that the reaction of the different hospital types to the public policy aimed to reduced the DRG distortions is different. Private hospitals tend to reduce the DRGs while the public hospitals increase the readmissions. Last, private hospitals are less efficient than public and not–for–profit ones, once we take the DRG distortions (and other covariates) into account, both for the SF approach and the ML model
The effect of a law limiting upcoding on hospital admissions: evidence from Italy
No full textPolicy makers have made several attempts to limit hospitals’ upcoding. We investigate the impact of a law introducing a minimum length of stay for discharges with complications. We analyze its effects on the probability of a discharge with complications, on its length of stay and on its reimbursement. We show that the policy has been effective in limiting upcoding, since, after the law, (1) the probability of a discharge with complications has decreased by 3%; (2) its length of stay has risen by 0.17 days more than the observed corresponding variation in the length of stay of a discharge in the control group; (3) the hospital’s revenue on a discharge with complications has decreased by 8.5% more than the observed revenue change on a discharge in the control group. Furthermore, we find evidence of an ownership effect on upcoding, since not-for-profit and for-profit hospitals have been more affected by the law than public hospitals
The effects of upcoding, cream skimming and readmissions on the Italian hospitals efficiency: a population-based investigation
No full textIn this paper we analyze the effects of some distortions induced by the prospective payment system, i.e. upcoding, cream skimming and readmissions, on hospitals' technical efficiency. We estimate a production function using a population-based dataset composed by all active hospitals in an Italian region during the period 1998–2007. We show that cream skimming and upcoding have a negative impact on hospitals' technical efficiency, while readmissions have a positive effect. Moreover, the results indicate that private hospitals engage more in cream skimming than public and not-for-profit ones, while we observe no ownership differences regarding upcoding. Not-for-profit hospitals have the highest readmission index. Last, not-for-profit and public hospitals have the same efficiency levels, while private hospitals have the lowest technical efficiency
Effect of a law limiting upcoding on hospitals’ admissions: evidence from Italy
Get PDFPolicy 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
Impatto del sistema di finanziamento a DRG sull’innovazione tecnologica in sanità. Il caso italiano
No full textNegli ultimi vent’anni, la maggior parte dei paesi sviluppati ha introdotto schemi di pagamento prospettico basati sui DRG per rimborsare l’attività di ricovero ospedaliero. Tali schemi di pagamento possono giocare un ruolo importante nell’adozione di nuovi dispositive medici: quando un nuovo dispositivo entra sul mercato, la sua adozione può dipendere da valutazioni circa l’aumento dei costi ed il valore terapeutico aggiunto. L’obiettivo della presente ricerca è quello di (i) identificare, in un campione di regioni italiane, le caratteristiche dei sistemi regionali di rimborso dei ricoveri ospedalieri basati sui DRG rilevanti ai fini dell’adozione dell’innovazione tecnologica, descrivendo i meccanismi di aggiornamento del sistema di codici e tariffe che assicurano che essa sia incorporata nel sistema di rimborso ed individuando strumenti specifici di pagamento alternativi utilizzati in ambito ospedaliero per incentivarla; e (ii) investigare le opinioni e le percezioni degli operatori del Sistema Sanitario Nazionale sul ruolo del sistema di finanziamento basato sui DRG sull’adozione e sulla diffusione di dispositivi medici innovativi negli ospedali italiani
How to reduce inequity of access to cardiac rehabilitation after Surgical Aortic Valve Replacement. Recommendations for the post-COVID era from a real world, population-based study
No full textLittle data exist regarding cardiac rehabilitation (CR) access after valve surgery. Moreover, the factors affecting the probability of timely access to CR after surgical aortic valve replacement (SAVR) have never been empirically investigated. The aim of the study is to fill this gap and respond to the following two research questions: (i) How many SAVR patients do access a timely CR program after SAVR in Italy? (ii) To what extent is timely access to CR for SAVR patients influenced by specific characteristics of patients and hospitals
Competition and ownership effect on hospitals’ efficiency. A Simar–Wilson methodology analysis
No full textIn this paper we study the efficiency of 89 Italian hospitals between
1999 and 2006 using the two-stage procedure proposed by Simar and
Wilson (2007). In the first stage, we estimate the efficient frontier with
Data Envelopment Analysis. In the second stage, the Simar–Wilson
double bootstrap procedure is used to analyze the determinants of
efficiency. We find evidence that large hospitals are more efficient
than small ones, i.e. small hospitals have spare capacity since they
are more distant from the frontier than large ones. The truncated
regression on the estimated DEA scores shows that efficiency is not
influenced by ownership and teaching status. Competition, measured
in terms of share of beds per hospital specialty in competition within
a ray of 20 km, has a positive impact on hospitals technical efficiency.
Activity concentration, measured by the sum of squares of the share
of discharges per specialty, has a strong negative impact on efficiency,
meaning that those hospitals which specialize and provide a limited
number of services are less efficient. Last, we compute the Malmquist
TFP index, which highlights an increase in the average efficiency in
the Italian hospital sector due to a growing capacity of operating at
an optimal scale with a consequent reduction in average costs due to
the decrease of the scale of operation
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