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Comparison of cost-weights scales methodologies in the perspective of a financing system based on pathologies
1Département d'Economie de la Santé, CP592, Ecole de Santé Publique de l'Université Libre de Bruxelles, 806, Route de Lennik, 1070 Bruxelles, Belgium. magali.pirson@ulb.ac.be
Insights
This study explored creating a case-mix (CW) scale using Belgian hospital cost data to improve healthcare financing. A selected CW scale (No. 6) showed potential for a prospective payment system, impacting hospital income.
Area of Science:
- Health Economics
- Hospital Management
- Healthcare Financing
Background:
- Belgian hospitals face challenges in accurately reflecting real costs in their financing systems.
- Existing financing models may not adequately account for case-mix complexity and severity of illness.
- A need exists for a refined case-mix (CW) scale to ensure equitable hospital reimbursement.
Purpose of the Study:
- To assess the feasibility of developing a CW scale based on Belgian hospital cost data.
- To compare different methodologies for constructing an optimal CW scale for healthcare financing.
- To evaluate the financial implications of a revised hospital reimbursement system.
Main Methods:
- Development of twelve distinct CW scales using various data types, diagnostic-related groups (DRGs), and outlier detection methods.
- Comparative analysis of methodologies to identify the scale best approximating real hospital costs.
- Simulation of financial impacts on hospitals under a prospective payment system (PPS) using the selected CW scale.
Main Results:
- A specific CW scale (No. 6) was identified as suitable for a prospective financing system.
- Hospitals H2 and H5 demonstrated potential for increased financing under the proposed system.
- Simulated financial adjustments indicated potential reductions in financing ranging from -1% to -9% for some hospitals.
Conclusions:
- The developed cost database and CW scale methodology represent a potential first step towards implementing a prospective payment system in Belgium.
- Establishing regional healthcare cost databases and coordinating methodological approaches at the federal level is recommended.
- Further evaluation of the advantages of a prospective payment system is necessary for successful implementation.
Objectives:
Objectives of this article are to evaluate the possibility to create a CW scale by pathology on the basis of cost data from Belgian hospitals, to compare several methodologies to create this CW scale, and to evaluate the financial impact of a modification of the financing system on hospitals' income.
Methods:
CW scales were elaborated according to various methodologies in order to isolate the scale allowing the most adequate financing system, i.e. approaching the real costs as much as possible. Twelve scales were created. They vary according to the type of data used, according to DRGs and severities of illness included within the scale, and according to the variable used in order to isolate outliers.
Results:
For a similar case-mix, Hospitals H2 and H5 would see their financing increased through a prospective system based on the selected CW scale (No. 6). This modification would generate a reduction in financing going from -1 to -9% according to hospitals.
Conclusions:
The cost database created made it possible to create a CW scale according to a technique which could constitute the first step of a PPS if advantages of a such financing system were established. In the Belgian context, it would be probably judicious to envisage regional databases allowing diversified methodological approaches whose results would be confronted, discussed, and coordinated at the federal level.
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