Improving managed competition by homogenizing the Dutch DBC

摘要: Summary BACKGROUND: In 2009, 12 percent of the annual gross domestic product was spent on health care in Netherlands, which is more than most other OECD countries. Governmental budgets Netherlands had to be cut and cost containment inevitable. To create awareness treatment, Diagnosis Treatment Combinations (DBC) system introduced. control costs, all players need know patients their treatments are expensive. Therefore, it important that classified by adequate classification variables reflect differences between patient groups predict high treatment costs. This study will examine whether necessary increase homogeneity DBCs (current) able decrease variation. METHODS: this study, level data 2008 from Dutch DBC database inguinal hernia repair, appendectomy cholecystectomy within medical specialty Surgery were used for analyses. For each clinical pathway, relevant codes selected. Classification concerned both activities core variables. Ordinary Least Squares (OLS) regression ability explain variation patients. RESULTS: Although predictive very low, current explained 30 repair. Except characteristics seemed have a low ability. However, age has significant impact valid pathways. As expected, much variation. general pathways particularly physiotherapy, CT scans, echoes, review ECG, daycare hours, laboratory- microbiological services, open – laparoscopic procedure, inpatient- outpatient visit, pathological examination emergency visit. CONCLUSIONS: The choice grouping algorithm essential consequently result efficiency gains hospitals. Together with activities, can serve as additional variable groups. these results cannot represent determinants should taken into account, may help decision-making process improving new DOT (DBC towards transparency) system. Furthermore, might valuable implications relationships triangle care.