Abstract. This paper analyses the effects of the new Austrian performance-oriented inpatient payment system on discharge strategies of hospitals by investigating length-of-stay (LOS) distributions. Using generalised linear models applied to data from 1998, we calculate the impact of day and month of admission as well as types of admission and discharge on the LOS of inpatients with major diagnoses. Hereby, we prove significant interdependencies among these variables and reveal hospital behaviour such as 1) premature discharges of inpatients or “unbundling” and 2) “patient splitting”. Hence, our findings illustrate that hospitals react to incentives set by the new system in order to maximise their revenues. Hence, the current reimbursement system still has potential for cost reduction while maintaining high quality of health care. Our strategic policy model supports decision makers in disclosing these effects and provides policy implications to close exploitable gaps within the new reimbursement system.
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RID="We are grateful to experts of the federal funds and the Ministry of Labour, Health and Social Affairs for providing us with detailed information on the Austrian reimbursement system for inpatients and for approving our data request. In addition, we especially thank Dr. Wilhelm Frank of the Austrian Federal Institute for Health Care for making the needed inpatient data available for us. Special thanks are due to Professor Arjan Shahani, Paul Harper and Sally Brailsford (University of Southampton, United Kingdom), Professor Lucas Delesie (Catholic University of Leuven, Belgium), Professor Bernhard Schwarz (University of Vienna, Austria) and Professor Engelbert Dockner (University of Vienna, Austria) for valuable comments on this investigation.
Correspondence to:M. Rauner
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Rauner, M., Zeiles, A., Schaffhauser-Linzatti, MM. et al. Modelling the effects of the Austrian inpatient reimbursement system on length-of-stay distributions. OR Spectrum 25, 183–206 (2003). https://doi.org/10.1007/s00291-003-0120-z
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DOI: https://doi.org/10.1007/s00291-003-0120-z