Fischer: Components of Health Care Remuneration Systems.

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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