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Patient classification and hospital reimbursement for inguinal hernia repair: a comparison across 11 European countries

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Abstract

Purpose

This comparative study examines the categorisation of patients undergoing surgical repair of inguinal hernia in the diagnosis-related group (DRG) systems of 11 European countries (Austria, England, Estonia, Finland, France, Germany, Ireland, the Netherlands, Poland, Spain and Sweden). Understanding the design and operation of DRG systems for this common surgical procedure is important, given their increasing use internationally for hospital reimbursement and performance measurement.

Methods

A common definition was used to identify inguinal hernia patients and the corresponding data were extracted from national databases. The analysis compared the variables and algorithms for classifying these patients to DRGs across the participating countries, as well as the number, composition and relative resource intensity of groups. An index case and six standardised vignettes were grouped using each country’s DRG system and the associated quasi-prices were calculated.

Results

The number of groups to which inguinal hernia patients are assigned is typically three or four, but ranges from two in Poland to ten in France. In most systems, categorising patients is contingent on procedure, principal and secondary diagnoses, and age, with treatment setting (day case/inpatient) being less common. Added to these, the French system also incorporates length of stay and whether the patient died. More resource intensive DRGs generally contained patients who were older, treated as inpatients, did not die, had (more severe) complications and/or co-morbidities, and/or underwent laparoscopic repair. There are cross-country disparities in day case rates and the use of laparoscopic repairs.

Conclusions

The categorisation of inguinal hernia patients varies across the 11 European DRG systems under study. By highlighting the main differences across these systems, this comparative analysis allows the relevant decision makers to assess the adequacy and specificity of their own DRG systems.

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Notes

  1. Further details on the EuroDRG project, funded under the Seventh Framework Programme of the European Commission, are available at www.eurodrg.eu.

  2. In contrast, there are proposals to reduce the number of diagnose behandeling combinaties (DBCs) in the Netherlands from approximately 30,000–4,000 [8].

  3. The other EoCs were breast cancer surgery, acute myocardial infarction, coronary artery bypass graft, stroke, appendectomy, cholecystectomy, hip replacement, knee replacement and childbirth. Using a similar approach to that adopted in this paper, Quentin et al. [11] discuss the classification of appendectomy patients across the 11 participating countries.

  4. Further detailed information on each country’s DRG system is contained in Kobel et al. [6].

  5. Outliers generally refer to particularly complex and resource-intensive patients, whose costs are typically shared between the provider and the funder. See Cots et al. [23] for a discussion of the identification and reimbursement of outliers in the EuroDRG countries.

  6. For a broader discussion of the implications of the EuroDRG project, see Busse et al. [25].

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Acknowledgments

The findings and results presented in this article were conducted within the research project ‘EuroDRG-Diagnosis-Related Groups in Europe: towards efficiency and quality’, which was funded by the European Commission under the Seventh Framework Programme. Research Area: HEALTH-2007-3.2-8 European System of Diagnosis-Related Groups, Project reference: 223300, Call (part) identifier: FP7-HEALTH-2007-B. We are grateful to all our partners who made this work possible and especially to Wilm Quentin for his assistance in compiling Fig. 1 and defining the patient vignettes. We also acknowledge helpful comments received from the journal editors, two anonymous referees and Miriam Wiley.

Conflict of interest

LS declares no conflict of interest. JO’R declares no conflict of interest.

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Authors and Affiliations

  1. Department of Statistics and Comparisons, National Board of Health and Welfare, 106 30, Stockholm, Sweden

    L. Serdén

  2. Economic and Social Research Institute and Trinity College, Dublin, Ireland

    J. O’Reilly

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  1. L. Serdén
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  2. J. O’Reilly
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Correspondence to L. Serdén.

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On behalf of the EuroDRG group.

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Serdén, L., O’Reilly, J. Patient classification and hospital reimbursement for inguinal hernia repair: a comparison across 11 European countries. Hernia 18, 273–281 (2014). https://doi.org/10.1007/s10029-013-1158-8

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  • DOI: https://doi.org/10.1007/s10029-013-1158-8

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