Abstract
An inpatient is usually defined as a patient who is admitted to a hospital or clinic for treatment that requires at least one overnight stay. However, since 1 August 2006, and for reimbursement purposes, under Portuguese law the length of stay must be longer than 24 hours to be considered a valid inpatient stay. The Portuguese National Health System hospitals are financed through two different schemes. For patients with a third party responsible for health expenditure, the hospital charges a fixed price by DRG for each inpatient stay, and for some outpatient visits such as chemotherapy, ambulatory surgery, and dialysis, among others. For patients covered solely by the National Health System, hospitals are financed through an annual agreement. Under this agreement, there is a single fixed price for inpatient stays as well as those outpatient visits which have a DRG associated. Each type of production is valued by applying that price, adjusted by the case-mix index for that type, to the amount of equivalent inpatient stays (adjusted to the medium length of stay outside the considered normality limits) or outpatient visits. Stays under 24 hours, since they are registered as inpatient stays, are not eligible for inpatient reimbursement under either scheme. In addition, they are also not considered proper outpatient visits, and are not paid as such to the hospital. Even so, the hospital incurs costs with these patients, often including surgical procedures or other costly treatments. Our aim is to show how invalid inpatient stays affect both the hospital’s budget and funding.
Highlights
An inpatient is usually defined as a patient who is admitted to a hospital or clinic for treatment that requires at least one overnight stay
We proceeded to calculate their weight on the total number of inpatients for each hospital, the value the hospital would receive if those stays were registered as outpatient visits, and the impact of this latter value, as a percentage, on the hospital outpatient budget of the annual agreement
Having no direct knowledge of the costs involved in the treatment of these patients, and using their ambulatory price for DRG as a proxy, we may state that, to the hospitals, these stays imply an expenditure that amounts to € 1,109,903.98, for which they will not be reimbursed. The prevalence of these cases varied from hospital to hospital, ranging from 0.10% to 2.40% of the total of inpatients. The registry of these stays as outpatient visits, assuming all patients were covered by the National Health Service, would allow hospitals to receive further funding of € 878,875.57
Summary
An inpatient is usually defined as a patient who is admitted to a hospital or clinic for treatment that requires at least one overnight stay. For patients with a third party responsible for health expenditure, the hospital charges a fixed price by DRG for each inpatient stay, and for some outpatient visits such as chemotherapy, ambulatory surgery, and dialysis, among others. For patients covered solely by the National Health System, hospitals are financed through an annual agreement. Under this agreement, there is a single fixed price for inpatient stays as well as those outpatient visits which have a DRG associated. Each type of production is valued by applying that price, adjusted by the casemix index for that type, to the amount of equivalent inpatient stays (adjusted to the medium length of stay outside the considered normality limits) or outpatient visits
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
