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Improving patient-level costing in the English and the German 'DRG' system.

Health Policy 109, 290-300 (2013)
Open Access Green as soon as Postprint is submitted to ZB.
Objectives: The purpose of this paper is to develop ways to improve patient-level cost apportioning (PLCA) in the English and German inpatient 'DRG' cost accounting systems, to support regulators in improving costing schemes, and to give clinicians and hospital management sophisticated tools to measure and link their management. Methods: The paper analyzes and evaluates the PLCA step in the cost accounting schemes of both countries according to the impact on the key aspects of DRG introduction: transparency and efficiency. The goal is to generate a best available PLCA standard with enhanced accuracy and managerial relevance, the main requirements of cost accounting. Results: A best available PLCA standard in 'DRG' cost accounting uses: (1) the cost-matrix from the German system; (2) a third axis in this matrix, representing service-lines or clinical pathways; (3) a scoring system for key cost drivers with the long-term objective of time-driven activity-based costing and (4) a point of delivery separation. Conclusion: Both systems have elements that the other system can learn from. By combining their strengths, regulators are supported in enhancing PLCA systems, improving the accuracy of national reimbursement and the managerial relevance of inpatient cost accounting systems, in order to reduce costs in health care.
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Publication type Article: Journal article
Document type Scientific Article
Keywords Hospital Costing ; Accounting ; Cost Apportioning ; Payment By Results ; Healthcare Resource Groups ; Diagnosis Related Groups; Health-care ; Clinical Pathways ; Efficiency ; Ownership
ISSN (print) / ISBN 0168-8510
e-ISSN 1872-6054
Journal Health Policy
Quellenangaben Volume: 109, Issue: 3, Pages: 290-300 Article Number: , Supplement: ,
Publisher Elsevier
Reviewing status Peer reviewed