The sensitivity of hospital coding to prices: evidence from Indonesia.

IF 1.5 4区 经济学 Q3 BUSINESS, FINANCE
Martin Chalkley, Budi Hidayat, Royasia Viki Ramadani, María José Aragón
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Abstract

This study examines a newly introduced DRG system in Indonesia. We use secondary data for 2015 and 2017 from Jaminan Kesehatan Nasional (JKN), a patient level dataset for Indonesia created in 2014 to record public and private hospitals' claims to the national health insurance system to investigate whether there is an association between changes in tariffs paid and the severity of inpatient activity recorded in hospitals. We find a consistent small, positive and statistically significant correlation between changes in tariffs and changes in concentration of activity, indicating discretionary but limited coding behaviour by hospitals. The results indicate that reducing price differentials may mitigate discretionary coding, but that the benefits of this are limited and need to be compared to the potential risk of having to rebase all prices upwards.

Abstract Image

医院编码对价格的敏感性:印度尼西亚的证据。
本研究探讨了印度尼西亚新引入的 DRG 系统。我们利用印度尼西亚国家医疗保险局(JKN)2015 年和 2017 年的二级数据(JKN 是印度尼西亚于 2014 年创建的一个患者级别数据集,用于记录公立和私立医院向国家医疗保险系统提出的索赔),研究支付关税的变化与医院记录的住院病人活动的严重程度之间是否存在关联。我们发现,收费标准的变化与活动集中度的变化之间始终存在着微小的、正向的、统计意义上的相关性,这表明医院有自由裁量权,但编码行为有限。结果表明,缩小价格差异可减轻随意编码行为,但这样做的益处是有限的,而且需要与必须上调所有价格的潜在风险进行比较。
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来源期刊
CiteScore
3.60
自引率
0.00%
发文量
18
期刊介绍: The focus of the International Journal of Health Economics and Management is on health care systems and on the behavior of consumers, patients, and providers of such services. The links among management, public policy, payment, and performance are core topics of the relaunched journal. The demand for health care and its cost remain central concerns. Even as medical innovation allows providers to improve the lives of their patients, questions remain about how to efficiently deliver health care services, how to pay for it, and who should pay for it. These are central questions facing innovators, providers, and payers in the public and private sectors. One key to answering these questions is to understand how people choose among alternative arrangements, either in markets or through the political process. The choices made by healthcare managers concerning the organization and production of that care are also crucial. There is an important connection between the management of a health care system and its economic performance. The primary audience for this journal will be health economists and researchers in health management, along with the larger group of health services researchers. In addition, research and policy analysis reported in the journal should be of interest to health care providers, managers and policymakers, who need to know about the pressures facing insurers and governments, with consequences for regulation and mandates. The editors of the journal encourage submissions that analyze the behavior and interaction of the actors in health care, viz. consumers, providers, insurers, and governments. Preference will be given to contributions that combine theoretical with empirical work, evaluate conflicting findings, present new information, or compare experiences between countries and jurisdictions. In addition to conventional research articles, the journal will include specific subsections for shorter concise research findings and cont ributions to management and policy that provide important descriptive data or arguments about what policies follow from research findings. The composition of the editorial board is designed to cover the range of interest among economics and management researchers.Officially cited as: Int J Health Econ ManagFrom 2001 to 2014 the journal was published as International Journal of Health Care Finance and Economics. (Articles published in Vol. 1-14 officially cited as: Int J Health Care Finance Econ)
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