Table 4.
Comparison of hospital (quasi) prices for appendectomy patients in Europe (in year 2008 Euros)
| Patient 1 | Patient 2 | Patient 3 | Patient 4 | Patient 5 | Patient 6 | Index case | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DRG (in-/outlier) | (Shadow) Price (Euros) | DRG (in-/outlier) | (Shadow) Price (Euros) | DRG (in-/outlier) | (Shadow) Price (Euros) | DRG (in-/outlier) | (Shadow) Price (Euros) | DRG (in-/outlier) | (Shadow) Price (Euros) | DRG (in-/outlier) | (Shadow) Price (Euros) | DRG (in-/outlier) | (Shadow) Price (Euros) | |
| Austriaa | MEL06.01B (inlier) | 2.273 € | MEL06.01A (inlier) | 3.049 € | MEL06.01C (outlier) | 2.089 € | MEL06.01B (outlier) | 1.864 € | MEL06.01B (inlier) | 2.273 € | MEL06.01B (day case) | 1.045 € | MEL06.01C | 1.877 € |
| Englandb | F82 (inlier) | 2.852 € | F81 (inlier) | 3.572 € | F81 (outlier) | 3.852 € | F82 (inlier) | 2.852 € | F82 (inlier) | 2.852 € | F82 (inlier) (day case) | 2.852 € | FZ20B | 2.657 € |
| Estoniac | 165 (inlier) | 860 € | 164 (inlier) | 1.323 € | 164 (inlier) | 1.323 € | 167 (inlier) | 562 € | 167 (inlier) | 562 € | 167 (inlier) | 562 € | 167 | 562 € |
| Finlandd | 166N (inlier) | 4.254 € | 166N (inlier) | 4.254 € | 166N (inlier) | 4.254 € | 167 (inlier) | 3.822 € | 167 (inlier) | 3.822 € | 167O | 3.144 € | 167 | 3.822 € |
| Francee | 06C081 (inlier) | 3.283 € | 06C082 (inlier) | 4.841 € | 06C084 (inlier) | 12.304 € | 06C091 (inlier) | 2.400 € | 06C091 (inlier) | 2.400 € | Not classifiable | – | 06C091 | 2.400 € |
| Germanyf | G22A (inlier) | 3.467 € | G07C (inlier) | 3.700 € | G07C (inlier) | 3.700 € | G23B (inlier) | 2.111 € | G23B (inlier) | 2.111 € | Not classifiable | – | G23C | 1.990 € |
| Irelandg | G07B (inlier) | 4.645 € | G07A (inlier) | 8.768 € | G07A (inlier) | 8.768 € | G07B (inlier) | 4.645 € | G07B (inlier) | 4.645 € | Not classifiable | G07B | 4.645 € | |
| Netherlands | 0303.11.113.203 | 3.058 € | 0303.11.113.203 | 3.058 € | 0303.11.113.203 | 3.058 € | 0303.11.113.203 | 3.058 € | 0303.11.113.303 | 3.585 € | 0303.11.113.301 | 1.422 € | 0303.11.113.203 | 3.058 € |
| Poland | F82 (inlier) | 1.005 € | F82 (inlier) | 1.005 € | F82 (inlier) | 1.005 € | F83 (inlier) | 685 € | F83 (inlier) | 685 € | F83 (inlier) | 685 € | F83 | 685 € |
| Spainh | 165 | 4.359 € | 553 | 12.563 € | 164 | 7.311 € | 167 | 2.657 € | 883 | 2.822 € | 883 | 2.822 € | 167 | 2.657 € |
| Sweden | 166N (inlier) | 5.009 € | 166N (inlier) | 5.009 € | 166N (inlier) | 5.009 € | 167 (inlier) | 3.499 € | 167 (inlier) | 3.499 € | 167O | 1.528 € | 167 | 3.499 € |
aReported values are based on theoretically calculated scores. Actual hospital reimbursement depends on decisions of states, which make use of nationwide DRG scores in different ways. Patient 6 has a length of stay = 0 but would NOT be considered an outpatient
bBased on 2008/9 tariff prices and HRG version 3.5. All relevant to-ups are included in the shown tariff. HRG 4 reimbursements could not be determined. Reported figures are reimbursements for emergency admissions. Elective admissions receive a different tariff. Patient 6 has a length of stay = 0, but would NOT be classified as an outpatient
cShadow prices were calculated by multiplying cost weights with the national base rates. In actual reimbursement, hospitals are paid through a mix of DRG based reimbursement and fee-for-service. The actual DRG based reimbursement is only 70% of the reported shadow price with the remaining 30% being related to fee-for-service payments
dActual reimbursement varies by type of hospital (i.e., university, central, local hospitals) and hospital district. Provided figures are volume weighted averages across all hospitals. Outlier limits differ between hospital districts. In some hospital districts, patient 3 might be considered an outlier. In this case certain surcharges based on per diems might be applied
eReported prices are for public sector hospitals since private hospital prices do not reflect full costs
fCalculated using national DRG cost weights and the average of state-wide base rates
gCalculated using AR-DRG V 5.1 and the national average inpatient ‘base price’ of €5,219 for a relative value of 1 and the other casemix parameters (including low and high length of stay trim points) from the 2009 inpatient casemix model (used to estimate the 2010 casemix budgetary adjustments on the basis of 2008 activity and cost data)
hAP-DRGs in Spain are used when patients receive care in non-resident autonomous communities (ACs). The price shown in the last column is the rate that would be paid for these patients, calculated by multiplying national Spanish cost weights with the national base rate. The payment to hospitals for all other patients depends on the hospital payment system in the relevant autonomous community. When using AP-DRGs in Spain, inliers/outliers are not determined