Predicting diagnostic coding in hospitals: individual level effects of price incentives
Peer reviewed, Journal article
Published version
Permanent lenke
https://hdl.handle.net/11250/2789056Utgivelsesdato
2021Metadata
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Originalversjon
10.1007/s10754-021-09314-5Sammendrag
The purpose of this paper is to test if implicit price incentives infuence the diagnostic coding of hospital discharges. We estimate if the probability of being coded as a complicated
patient was related to a specifc price incentive. This paper tests empirically if upcoding
can be linked to shifts in patient composition through proxy measures such as age composition, length of stay, readmission rates, mortality- and morbidity of patients. Data about
inpatient episodes in Norway in all specialized hospitals in the years 1999–2012 were collected, N=11 065 330. We examined incentives present in part of the hospital funding
system. First, we analyse trends in the proxy measures of diagnostic upcoding: can hospital behavioural changes be seen over time with regards to age composition, readmission
rates, length of stay, comorbidity and mortality? Secondly, we examine specifc patient
groups to see if variations in the price incentive are related to probability of being coded
as complicated. In the frst years (1999–2003) there was an observed increase in the share
of episodes coded as complicated, while the level has become more stable in the years
2004–2012. The analysis showed some indications of upcoding. However, we found no
evidence of widespread upcoding fuelled by implicit price incentive, as other issues such
as patient characteristics seem to be more important than the price diferences. This study
adds to previous research by testing individual level predictions. The added value of such
analysis is to have better case mix control. We observe the presence of price efects even at
individual level.