Z I M - Note Funding Nov. 1998
Last update: Aug. 2001

Components of Health Care Remuneration Systems

Wolfram Fischer

Zentrum für Informatik und wirtschaftliche Medizin
CH-9116 Wolfertswil SG (Switzerland)
http://www.fischer-zim.ch/

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Inhaltsübersicht

1. General Scheme to Describe Remuneration Models
2. Example of Remuneration Models
3. References

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1. General Scheme to Describe Remuneration Models

Remuneration System (Overview)


R e m u n e r a t i o n M o d e l

" P r i c e L i s t "

Abb. 1: Basic Scheme

Remuneration System

Setting

Funding Model

R e m u n e r a t i o n M o d e l

Health Care Product Types

Scope of Regulations

Payment Components

" P r i c e L i s t "

Product Description			Prices
Service Bundles	Units	Characteristics	Figures	Payments

Constructions Principles

Calculations Methods

Abb. 2: Detailled Scheme

Remuneration System
for Inpatient Treatment

Setting:
- inpatient treatment
- inpatient+outpatient
- treatment episodes (inpat.+amb.)
- . . .

Funding Model:
- one/more financial sources
- budgeting/caps
- with/without deficit compensation
- . . .

R e m u n e r a t i o n M o d e l

Health Care Product Types:
- treatment
- others

Scope of Regulations:
- nation
- region
- group of hospitals
- one hospital

Payment Components:
- basic payments
- modifications

" P r i c e L i s t "

Product Description			Prices
Service Bundles: - patient categories	Units: - "case"	Characteristics: - ??	Figures: - cost weights - length of stays - trimpoints	Payments: - fixed payments per case - outlier payments

PCS Constructions Principles

Calculations Methods
(cost weights, length of stays, ...)

Abb. 3: Scheme "Inpatient Treatment"

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2. Example of Remuneration Models

DRG Based Remuneration System

Setting:
- inpatient treatment
- + day surgery ?

Funding Model:
- . . .

R e m u n e r a t i o n M o d e l

Health Care Product Types:
- treatment
- + others ?

Scope of Regulations:
- . . .

Payment Components:
- . . .

" P r i c e L i s t "

Product Description			Prices
Service Bundles: - HCFA-DRG - AP-DRG - APR-DRG	Units: - "case" (?)	Characteristics: - . . .	Figures: recalculate !	Payments: recalculate !

DRG Constructions Principles

Calculations Methods
- . . .

Abb. 4: DRG Embedding

. . .

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3. References

[1] Fischer W: Patientenklassifikationssysteme zur Bildung von Behandlungsfallgruppen im stationären Bereich - Prinzipien und Beispiele (Patient Classification Systems for Grouping Hospital Cases - Principles and Examples). BSV and Z/I/M, Bern and Wolfertswil 1997: 514 pp.

[2] Fischer W: Multidimensionality as an Alternative Approach to Construct Patient Classification Systems. In: Proceedings of the 14th PCS/E International Working Conference. Manchester, 1998:294.

[3] Fischer W: PCS and Casemix Types. In: Proceedings of the 11th PCS/E International Working Conference. Oslo, 1995:50-7.

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Z I M - Zentrum für Informatik und wirtschaftliche Medizin
CH-9116 Wolfertswil (SG), Steigstrasse 12, Switzerland
E-mail: , Tel: +41 71 3900 444

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