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dc.contributor.authorKeller, Patrick-
dc.contributor.authorRiguzzi, Marco-
dc.contributor.authorDettling, Marcel-
dc.contributor.authorWieser, Simon-
dc.date.accessioned2018-04-04T12:53:37Z-
dc.date.available2018-04-04T12:53:37Z-
dc.date.issued2017-
dc.identifier.urihttps://digitalcollection.zhaw.ch/handle/11475/4746-
dc.descriptionOral Presentationde_CH
dc.description.abstractObjectives: Inpatient psychiatric care in Switzerland is currently reimbursed by uniform per-diem rates. The new Health Insurance Act mandates the introduction of a national tariff system which reflects differences in resource use across patients based on observable patient characteristics. In this study we develop a prospective payment system (PPS). Data: Primary data on patient characteristics, cost per episode and daily time spent by medical staff were collected in a survey of 18’385 patients from 20 inpatient psychiatric facilities in 2014, representing roughly one third of the annual total. Patient characteristics include the main psychiatric diagnosis (ICD-10) and a weekly assessment of the severity of illness using the Health of Nations Outcome Scales questionnaire (HoNOS). Methods: Predictors of per-diem cost are examined with a multivariate linear regression model. Explanatory variables include the main psychiatric diagnosis, HoNOS scores, socio-demographic characteristics, type of insurance plan, compulsory hospitalization, emergency hospitalization, and hospital fixed effects. Furthermore, a staggered progression of per-diem cost over time is modelled. Different variants of the tariff structure are evaluated, some of which include intentional deviation of the tariff from the true distribution of costs in order to set incentives. Goodness-of-fit is evaluated by an out-of-sample evaluation of several statistical measures of the deviation of hypothetical revenues and observed costs, such as the mean absolute percentage error (MAPE). Results: Compared to the uniform per-diem tariff presently in operation in Switzerland, the PPS are capable of improving the accuracy of the tariff from a MAPE value of 25.2% to approximately 21.0%. The analysis yields several variants of PPS which are equivalent in terms of goodness-of-fit, but differ in terms of the patient characteristics used and with respect to financial incentives for hospitals. The main model constitutes a per-diem payment which is differentiated over three phases of treatment; the first week, days 8 to 60, and from the 61-st day onward. The payment is further determined by 11 diagnostic groups, scores in three out of the 12 dimensions of the HoNOS questionnaire (aggression, non-accidental self-injury, somatic comorbidity), and three age-related groups. Discussion: The proposed PPS combines incentives for an appropriate provision of care with incentives for a reduction of length of stay. Policy makers should take into account the different incentives implied by the alternative variants. While the PPS yields a set of adjusting factors for the payment, the Swiss system requires hospital-specific per-diem base rates to be negotiated between the mental health facilities and the insurers.de_CH
dc.language.isoende_CH
dc.publisherInternational Center of Mental Health Policy and Economicsde_CH
dc.rightsLicence according to publishing contractde_CH
dc.subject.ddc338: Produktionde_CH
dc.subject.ddc362: Gesundheits- und Sozialdienstede_CH
dc.titleProspective payment for inpatient psychiatric care : a system to be developed for Switzerlandde_CH
dc.typeKonferenz: Sonstigesde_CH
dcterms.typeTextde_CH
zhaw.departementSchool of Engineeringde_CH
zhaw.departementSchool of Management and Lawde_CH
zhaw.organisationalunitInstitut für Datenanalyse und Prozessdesign (IDP)de_CH
zhaw.organisationalunitWinterthurer Institut für Gesundheitsökonomie (WIG)de_CH
zhaw.conference.detailsThirteenth Workshop on Costs and Assessment in Psychiatry, Venice, Italy, 24-26 March 2017de_CH
zhaw.funding.euNode_CH
zhaw.originated.zhawYesde_CH
zhaw.publication.statuspublishedVersionde_CH
zhaw.publication.reviewNot specifiedde_CH
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Keller, P., Riguzzi, M., Dettling, M., & Wieser, S. (2017). Prospective payment for inpatient psychiatric care : a system to be developed for Switzerland. Thirteenth Workshop on Costs and Assessment in Psychiatry, Venice, Italy, 24-26 March 2017.
Keller, P. et al. (2017) ‘Prospective payment for inpatient psychiatric care : a system to be developed for Switzerland’, in Thirteenth Workshop on Costs and Assessment in Psychiatry, Venice, Italy, 24-26 March 2017. International Center of Mental Health Policy and Economics.
P. Keller, M. Riguzzi, M. Dettling, and S. Wieser, “Prospective payment for inpatient psychiatric care : a system to be developed for Switzerland,” in Thirteenth Workshop on Costs and Assessment in Psychiatry, Venice, Italy, 24-26 March 2017, 2017.
KELLER, Patrick, Marco RIGUZZI, Marcel DETTLING und Simon WIESER, 2017. Prospective payment for inpatient psychiatric care : a system to be developed for Switzerland. In: Thirteenth Workshop on Costs and Assessment in Psychiatry, Venice, Italy, 24-26 March 2017. Conference presentation. International Center of Mental Health Policy and Economics. 2017
Keller, Patrick, Marco Riguzzi, Marcel Dettling, and Simon Wieser. 2017. “Prospective Payment for Inpatient Psychiatric Care : A System to Be Developed for Switzerland.” Conference presentation. In Thirteenth Workshop on Costs and Assessment in Psychiatry, Venice, Italy, 24-26 March 2017. International Center of Mental Health Policy and Economics.
Keller, Patrick, et al. “Prospective Payment for Inpatient Psychiatric Care : A System to Be Developed for Switzerland.” Thirteenth Workshop on Costs and Assessment in Psychiatry, Venice, Italy, 24-26 March 2017, International Center of Mental Health Policy and Economics, 2017.


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