KOPS - The Institutional Repository of the University of Konstanz

Buying efficiency: optimal hospital payment in the presence of double upcoding

Buying efficiency: optimal hospital payment in the presence of double upcoding

Cite This

Files in this item

Checksum: MD5:56a61e9b2b7e652b97f08f765a05037a

SPIKA, Simon B., Peter ZWEIFEL, 2019. Buying efficiency: optimal hospital payment in the presence of double upcoding. In: Health economics review. 9(1), 38. eISSN 2191-1991. Available under: doi: 10.1186/s13561-019-0256-4

@article{Spika2019-12-28Buyin-48795, title={Buying efficiency: optimal hospital payment in the presence of double upcoding}, year={2019}, doi={10.1186/s13561-019-0256-4}, number={1}, volume={9}, journal={Health economics review}, author={Spika, Simon B. and Zweifel, Peter}, note={Article Number: 38} }

2020-02-25T12:54:43Z 2020-02-25T12:54:43Z Zweifel, Peter Spika, Simon B. Background:<br />With DRG payments, hospitals can game the system by 'upcoding' true patient's severity of illness. This paper takes into account that upcoding can be performed by the chief physician and hospital management, with the extent of the distortion depending on hospital's internal decision-making process. The internal decision making can be of the principal-agent type with the management as the principal and the chief physician as the agent, but the chief physicians may be able to engage in negotiations with management resulting in a bargaining solution.<br /><br />Results:<br />In case of the principal-agent mechanism, the distortion due to upcoding is shown to accumulate, whereas in the bargaining case it is avoided at the level of the chief physician.<br /><br />Conclusion:<br />In the presence of upcoding it may be appropriate for the sponsor to design a payment system that fosters bargaining to avoid additional distortions even if this requires extra funding. eng Buying efficiency: optimal hospital payment in the presence of double upcoding 2019-12-28 Zweifel, Peter Spika, Simon B.

Downloads since Feb 25, 2020 (Information about access statistics)

Spika_2-1cfl00oppl45b7.pdf 10

This item appears in the following Collection(s)

https://creativecommons.org/licenses/by/4.0 Except where otherwise noted, this item's license is described as https://creativecommons.org/licenses/by/4.0

Search KOPS


Browse

My Account