Managerial workarounds in three European DRG systems
Managerial workarounds in three European DRG systems (Emerald Insight).
Attempts to transform health systems have in many countries involved starting to pay healthcare providers through a DRG system, but that has involved managerial workarounds. Managerial workarounds have seldom been analysed. This paper does so by extending and modifying existing knowledge of the causes and character of clinical and IT workarounds, to produce a conceptualisation of the
managerial workaround. It further develops and revises this conceptualisation
by comparing the practical management, at both provider and purchaser levels,
of hospital DRG payment systems in England, Germany and Italy.
Managers in all three countries developed very similar workarounds to contain
healthcare costs to payers. To weaken DRG incentives to increase hospital
activity, managers agreed to lower DRG payments for episodes of care above an
agreed case-load ‘ceiling' and reduced payments by less than the full DRG
amounts when activity fell below an agreed ‘floor' volume.
In the case of DRGs, the managerial workarounds were instances of ‘constructive
deviance' which enabled payers to reduce the adverse financial consequences,
for them, arising from DRG incentives. The understanding of apparent failures
or part-failures to transform a health system can be made more nuanced,
balanced and diagnostic by using the concept of the ‘managerial workaround'.
Quelle: Emerald Insight, 08.02.2020