6533b822fe1ef96bd127ca0f

RESEARCH PRODUCT

Modeling of medical activity heterogenity to improve the hospital management by diagnosis-related groups

subject

description

Since the early 1980s healthcare systems in the industrialized nations have been undergoing radical reform aimed at curbing overspending of hospital expenditure. After a discussion of the limits of a prospective payment due to heterogeneity of costs within DRGs, we demonstrate the ability of anovel statistical model to identify high cost patients. We derive from this statistical model an economic heuristic in order to account for high cost patients in budget allocation and a Structural and Contingent method is proposed as a budgeting tool. Economic analysis based on this modeling of DRG heterogeneity further reveals the potential for improving the equity and the efficiency of the prospective payment system by restricting its perverse effects. This model may also be used as a strategic management tool for hospitals or as a means for regulators to evaluate treatment andadmission practices so as to improve health care provision. This statistical analysis was designed on the basis of a mixture of Weibull distribution, inwhich proportion of high-cost patients was expressed according to the multinomial logistic regression, allowing the determination of high-cost factors. An application of the statistical model to 124 DRGs on a French reference database stresses the problem o f heterogeneity of costs and length ofstays within most of DRGs. An example of identification of explanatory variables of high costs is carried out on several DRGs. The economic application of the statistical model is discussed pointing out the implications, in terms of efficiency, of improving hospital management. The other advantageof this statistical model is to allow the assessment of a revision of the DRG classification from both statistical and economic point of views.