Abstract
BackgroundPsychiatric comorbidities are relevant for the diagnostic and therapeutic regimes in somatic hospital care. The main aim of this study was to analyse the association between psychiatric comorbidities and hospital costs per inpatient episode. A further aim was to discuss and address the methodological challenges in the estimation of these outcomes based on retrospective data.MethodsThe study included 338,162 inpatient episodes consecutively discharged between 2011 and 2014 at a German university hospital. We used detailed resource use data to calculate day-specific hospital costs. We adjusted analyses for sex, age, somatic comorbidities and main diagnoses. We addressed potential time-related bias in retrospective diagnosis data with sensitivity analyses.ResultsPsychiatric comorbidities were associated with an increase in hospital costs per episode of 40% and an increase of reimbursement per episode of 28%, representing marginal effects of 1344 € and 1004 €, respectively. After controlling for length of stay, sensitivity analyses provided a lower bound increase in daily costs and reimbursement of 207 € and 151 €, respectively.ConclusionIf differences in hospital costs between patient groups are not adequately accounted for in DRG-systems, perverse incentives are created that can reduce the efficiency of care. Therefore, we suggest intensifying the inclusion of psychiatric comorbidities in the German DRG system. Future research should investigate the appropriate inclusion of psychiatric comorbidities in other health care systems’ payment schemes.
Highlights
Psychiatric comorbidities are relevant for the diagnostic and therapeutic regimes in somatic hospital care
If differences in hospital costs between patients are not adequately controlled for in Diagnosis-related Groups (DRG)-systems, i.e. the payment is either too high or too low for many patients, such perverse incentives are created that can result in inefficient delivery of hospital services [11]
The main aim of this study was to analyse the association between psychiatric comorbidities and hospital costs and revenues per inpatient episode
Summary
Psychiatric comorbidities are relevant for the diagnostic and therapeutic regimes in somatic hospital care. The cumulated global reduction of economic output due to mental disorders was estimated to be US $16 trillion from 2010 to 2030 [2]. Despite these high social costs, mental health has not achieved commensurate visibility, policy attention or funding [3]. DRGs use patient classifications systems with the aim to create cost homogenous groups that serve to define lump-sum hospital reimbursement per group [7]. If differences in hospital costs between patients are not adequately controlled for in DRG-systems, i.e. the payment is either too high or too low for many patients, such perverse incentives are created that can result in inefficient delivery of hospital services [11]
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