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This study examines the changes in marginal revenue during psychiatric inpatient stays in a large Swiss psychiatric hospital after the introduction of a mixed reimbursement system with tariff rates that vary over length of stay. A discrete time duration model with a difference-in-difference specification and time-varying coefficients is estimated t...
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... This phenomenon is often referred to as strategic discharge behavior. Such behavior was confirmed by many recent papers: Medicare long-term acute care -Einav, Finkelstein, and Mahoney [3], Eliason et al. [4], mental healthcare-Douven, Remmerswaal, and Mosca [2], sepsis care-Bäuml and Kümpel [1], etc. Pletscher [11] in psychiatric care in Switzerland found that changes in marginal revenue per inpatient day can affect lengths of stay in the case of patients where the financial incentive was sufficiently large, while Pott et al. (2021) found no significant distortion in psychiatric care in Germany Pletscher [11], Pott et al. [12]. Whether or not such behavior is present is a pivotal question when designing optimal healthcare financing arrangements. ...
... This phenomenon is often referred to as strategic discharge behavior. Such behavior was confirmed by many recent papers: Medicare long-term acute care -Einav, Finkelstein, and Mahoney [3], Eliason et al. [4], mental healthcare-Douven, Remmerswaal, and Mosca [2], sepsis care-Bäuml and Kümpel [1], etc. Pletscher [11] in psychiatric care in Switzerland found that changes in marginal revenue per inpatient day can affect lengths of stay in the case of patients where the financial incentive was sufficiently large, while Pott et al. (2021) found no significant distortion in psychiatric care in Germany Pletscher [11], Pott et al. [12]. Whether or not such behavior is present is a pivotal question when designing optimal healthcare financing arrangements. ...
... Earlier research has shown that healthcare providers respond to abrupt increases in reimbursement schedules by extending treatments to reach the higher tariff and then discharging patients directly following the threshold (e.g., Einav, Finkelstein, and Mahoney [3], Eliason et al. [4], while Pletscher [11] found that such distortions were only significant for patients where the financial incentive was sufficiently large and Pott et al. [12] found no significant distortion at all. The purpose of our study is to evaluate a similar financial incentive in the context of rehabilitation care in the Netherlands. ...
Non-linear reimbursement contracts in healthcare have been increasingly used to quantify providers’ responses to financial incentives. In the present research, we utilize a large one-off increase in the reimbursement of rehabilitation care to assess to what extent providers are willing to modify their treating behavior to maximize profits. In order to disincentivize the use of short inpatient stays for rehabilitation care, Dutch policy-makers have instated a two-part stepwise tariff-schedule. A lower tariff-schedule is applied for short hospital stays (≤ 14 days), while a higher tariff-schedule is utilized for longer treatments. Switching from one schedule to the other at day 15 of inpatient care leads to a sudden and large increase in tariffs. We show that, for most care-types, patients are seldom treated in an inpatient setting for less than 15 days, while the majority of patients are discharged after the threshold. Therefore, we conclude that the financial incentive at day 15 leads to considerable distortions in treatment. However, instead of discharging all patients at the threshold point where marginal tariffs are maximized, providers tend to continue treatment indicating altruistic behavior. As healthcare payment systems move away from piecewise reimbursement (e.g., fee-for-service arrangements), and services are increasingly ‘lumped’ together into e.g., DRGs and bundled payments, the likelihood of such discontinuities in tariff-schedules radically increases. Our research illustrates how such discontinuities in reimbursements can lead to distortions in the amount of healthcare provided contributing to the debate on optimal healthcare contracting design.
... Several studies address reimbursement incentives induced by discontinuously per diem prospective payment. Using data on inpatient psychiatric patients in Switzerland, Pletscher [17] examined whether the introduction of a mixed reimbursement system led to changes in the timing of discharge. The reimbursement scheme consisted of relatively high per diem rates up to day 5, a per case payment on day 6 and comparably lower per diem rates for all subsequent days of treatment. ...
... Patients for whom mixed tariffs and government contributions in the form of retrospective annual payments based on accumulated losses were reimbursed, no significant effect could be detected. Pletscher [17] concludes that the reduction in marginal revenue must be sufficiently large to establish incentives to reduce LOS. ...
... For the second subgroup analysis, we only considered the first hospital stay of each individual in the observation period. As Pletscher [17] suggests, marginal price effects are larger among moderately ill compared to severely ill patients. Assuming that patients who are readmitted to psychiatric hospitals are sicker than those who are not [40], our 2015 sample may be biased towards severe cases. ...
This paper examines the behaviour of mental health care providers in response to marginal payment incentives induced by a discontinuous per diem reimbursement schedule with varying tariff rates over the length of stay. The analyses use administrative data on 12,627 cases treated in 82 psychiatric hospitals and wards in Germany. We investigate whether substantial reductions in marginal reimbursement per inpatient day led to strategic discharge behaviour once a certain length of stay threshold is exceeded. The data do not show gaps and bunches at the duration of treatment when marginal reimbursement decreases. Using logistic regression models, we find that providers did not react to discontinuities in marginal reimbursement by significantly reducing inpatient length of stay around the threshold. These findings are robust in terms of different model specifications and subsamples. The results indicate that if regulators aim to set incentives to decrease LOS, this might not be achieved by cuts in reimbursement over LOS.
... In this rapid scoping review, we describe six studies on policy programs that were successful at reducing delayed discharge/ALC (Appendix C). Each study targets a different jurisdiction, including France (Gandré et al., 2017a), Germany (Ignatyev et al., 2019), Scotland , Switzerland (Pletscher, 2016), South Korea (Shin et al., 2017), and Australia (Osborne et al., 2018). ...
... The populations in the included studies were described as patients living with complex long-term needs, including the following groups: those with mental and cognitive illnesses (n = 4; (Gandré et al., 2017a); Ignatyev et al., 2019;Pletscher, 2016;, elderly patients at risk of prolonged hospitalization due to complex psychosocial needs (n = 1; Osborne et al., 2018), and cancer patients requiring palliative care (n = 1; Shin et al., 2017). ...
... The first category involved building long-term care supply and spaces in ambulatory or community care settings (Gandré et al., 2017a;Ignatyev et al., 2019;. The second category included interventions on payment reforms (Pletscher, 2016;Shin et al., 2017). Finally, the third category highlighted the creation of transition navigator roles overseeing patient discharge (Osborne et al., 2018). ...
Delayed discharge, also known as alternate level of care (ALC), is a longstanding challenge facing health systems globally. In Canada, ALC is a designation used to identify “patients that are receiving care in a setting where the intensity and type of care offered is no longer appropriate for their current needs.” According to the Canadian Institute for Health Information (CIHI), the percentage of patient days in hospitals that were designated ALC in 2017-2018 ranged across the provinces from 12% in British Columbia and 15% in Ontario to 21% in Prince Edward Island. Patients at risk of prolonged hospital stay include older adults, those with functional or cognitive impairments, those with multiple comorbidities, and those of marginalized sociodemographic status. In addition to using limited and expensive inpatient resources, ALC stays expose the often already frail patients to iatrogenic harms, such as hospital-acquired infections, functional decline, and social isolation. Delayed discharge is associated with a variety of factors, including individual patient circumstances, delayed assessment, lack of coordination and communication between hospitals and community settings, and limited supply of long-term care options (i.e., in the community and in facilities). Addressing these problems thus requires changes to both care delivery and policies that impact care (e.g., methods of funding, regulation, and other policy levers). The challenge of delayed discharge and ALC is not unique to Canada, and a number of comparable jurisdictions have introduced policy programs that have had some impact on reducing delayed discharge in recent years. For example, the implementation of the 2014 Care Act in the United Kingdom (UK) led to multiple country-specific policies across England, Wales, and Scotland, aimed at collectively reducing delayed discharges across the UK. The focus of this rapid review is to draw on published academic and grey literature from outside Canada to develop insight into some of the policy options governments may consider as they address the persistent challenge of delayed discharge/ALC. We are particularly interested in describing how policy programs have worked to reduce delayed discharge/ALC by implementing approaches to transfer people out of hospital to community-based settings rather than facility-based long-term care options.
... The effect of the lump sum measure was low, however [6]. Maybe this effect would have been increased if the reduction of revenue would have been greater [7]. ...
The aim of this study was to identify factors which are associated with the length of stay in a Swiss mental hospital. Demographical and clinical data of all patients who were admitted to the adult inpatient psychiatric service of the Federal State of Aargau in 2016 were examined regarding their association with the length of stay. The study sample included N = 1479 patients. Mean length of stay was 33 days and the median equalled 26 days. Higher age and a primary diagnosis of psychotic or affective disorder were associated with increased length of stay. In contrast, foreign nationality and compulsory admission were associated with reduced length of stay. While some of our findings were in line with recent findings from Italy and the United Kingdom, others could not be replicated.
Currently, most hospitals in Vietnam have Health Insurance services. Therefore, the hospital’s revenue includes the actual revenue from patients and the revenue paid by Health Insurance companies. Hospital revenue forecasting is essential in management, so that hospital leaders can make policies, plan advances, and make appropriate decisions. The hospital revenue forecast is a complex problem. The considered hospital revenue in this study is Health Insurance Company payment. This study mainly analyzes approaches to select neural network models in deep learning for forecast on two datasets of hospital revenue on the Health Information System of Vietnam Posts and Telecommunications Group (VNPT-HIS), recorded daily from 2018 to March 2021 in a provincial hospital of Ca Mau Province. Dataset 1 includes all revenue values recorded daily with 1182 records and an average value of 218 million VND. Dataset 2 does not include revenue values recorded on weekends or particular days with 982 records and an average value of 245 million VND. We adapt the models with both datasets by using different test sets for comparing the prediction performance. The empirical results show that the proposed method achieves positive results in both datasets. The models could produce acceptable prediction results. Therefore, the system could support the hospital manager in financial management activities.
