Abstract:
University Hospitals and DRGs

Diagnosis Related Groups (DRGs) are a tool to categorise acute inpatient stays with regard to severity. The resulting groups are expected to have similar costs. Nevertheless, average costs of patient stays at university hospitals are often higher than costs of stays at other hospitals even when they are weighted by DRG cost weights. Hence, the following questions arise:

• Are DRGs not able to map sufficiently well the differencies in hospital productions?
• Are there justifiable additional university hospital costs which should not be remunerated by DRG lump sums?
• Or did the performance be inefficient?

The Association of the German University Hospitals (VUD) ordered this study to be informed about the rules which other countries use to remunerate additional university hospital costs. The main investigations should be about regulations concerning the costs of patient treatment, additionally about postgraduate medical education and other missions of academic hospitals. The investigations should be made in Austria, Great Britain, the Netherlands and the USA.

The informations were gathered from public internet sites, and some email enquiries to experts.

The results show that all four countries accept that there are additional costs of university hospital patient treatment. But it is not easy to establish performance oriented remunerations. Rather seizable services (as intensive care, emergency admissions, costly drugs and devices) are remunerated partly within the country specific DRG based remuneration systems. The remaining additionals costs of patient treatment are explained and remunerated by different means:

• In Austria, additional costs per LDF point are remunerated through factors on the base rate. Additionally, the deficit is covered partially or fully by state and communities.
• In England, local price negotiations are seen as necessary. They are regulated explicitly as part of the PbR rules.
  Specialised services treatment of selected specialities – which is delivered oftenly only by university hospitals – is remunerated through factors on the base rate. The factors were proposed out of results of econometric model calculations, and adjusted (increased!) by political debates.
• In the Netherlands, there are state grants for top referral care, and the possibilty of price negotiations (though with defined maximal prices).
• In the USA, econometric model calculations are made. The hypothesis based results are the base of political debates. The remunerations are done by factors on the base rate.