Price and Volume Measures
of Hospital Services for
Germany
developed by Stefan Pierdzioch
presented by Liane Ritter
Federal Statistical Office, Germany
OECD Working Party on National Accounts in Paris,
14 - 16 October 2008
© Statistisches Bundesamt (Federal Statistical Office, Germany), Price and volume measurement
Content

DRG-based funding system for hospitals

Method for price and volume measures

Results
© Statistisches Bundesamt (Federal Statistical Office, Germany), Price and volume measurement
27.07.2016
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Funding System
Based on diagnostic related groups (DRGs)

From 2004 for all hospital services
(except psychiatric and rehabilitation hospitals)
 2006: 912 DRGs; 2007: 1082 DRGs
 27 major diagnostic categories (MDCs)
 DRG-dataset from 2005
 Number of treatments
 Cost weights
 Revenues
Base rates

Reference price a hospital charges for an average DRG
© Statistisches Bundesamt (Federal Statistical Office, Germany), Price and volume measurement
27.07.2016
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Major diagnostic categories 2006
Number
of DRGs
Share of
treatments
MDC
Major diagnostic categories
MDC 05
Diseases and disorders of the circulatory
system
109
15.5%
MDC 08
Diseases and disorders of the musculoskeletal system and connective tissues
105
14.3%
MDC 06
Diseases and disorders of the digestive
system
59
12.8%
…
…
MDC 15
Newborn
42
4.0%
…
…
912
100%
Total
© Statistisches Bundesamt (Federal Statistical Office, Germany), Price and volume measurement
27.07.2016
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DRG-Code
Example: B75A
“Febrile seizures, age of patient < 1 year”
DRG B75A
Major diagnosis
category MDC 01
„diseases and
disorders of the
nervous system“
diagnosis
Economic
complexity of the
diagnosis
(A – I; Z)
© Statistisches Bundesamt (Federal Statistical Office, Germany), Price and volume measurement
27.07.2016
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Price of a complete treatment (1)
Cost weights for DRGs

Example: DRG B75A: 0.531
 Between 0.106 and 64.899
 Valid for one calendar year
 Published three months before the reference year
Base rate (Insurance company)

Negotiated between hospitals and health insurances
 Up to 2008: by hospitals; from 2009: by regions (Länder)
 Actually paid base rate change during the year
Neglected

Extra payments
 Supplements for facultative services
© Statistisches Bundesamt (Federal Statistical Office, Germany), Price and volume measurement
27.07.2016
Folie 6
Price of a complete treatment (2)
Calculated DRG-revenues for treatments

Price of a treatment = cost weight x base rate

Example:
DRG B75A in hospital x
Cost weight: 0.531
Base rate: 2800 Euros
Price of one treatment “febrile seizures, age of patient < 1 year”
= 0.531 x 2800 Euros = 1487 Euros
DRG-revenues from the DRG-dataset not used

Small difference, yearly, too late
© Statistisches Bundesamt (Federal Statistical Office, Germany), Price and volume measurement
27.07.2016
Folie 7
Method (1)
Deflation


Weighting price developments with the number of treatments
Market production
Stratification



By 27 major diagnostic groups (MDCs)
No problems of regrouping
Stability of the structure
Weights: treatments MDCs



From DRG-dataset
Only yearly data
Nine months after the end of the reference year
Prices: average revenues per treatment for MDCs


Average base rates for all hospitals
Average cost weights for MDCs
© Statistisches Bundesamt (Federal Statistical Office, Germany), Price and volume measurement
27.07.2016
Folie 8
Method (2)

DRG 1
Average cost weight for a MDC
cost weight
1
X
quantity 1
+
DRG 2
cost weight
2
X
+
quantity 2
+
DRG 3

cost weight
3
X
quantity 1
quantity 2
average cost weight
major diagnosis
category
+
quantity 3
quantity 3
Average price for a MDC
= average cost weight for the MDG x average base rate

Development of the average prices for MDC
 Weighted by the number of treatments for the reference year
© Statistisches Bundesamt (Federal Statistical Office, Germany), Price and volume measurement
27.07.2016
Folie 9
Results (1)
Quarterly price change for hospital services
Quarter on quarter comparison, percentage
0,5
0,0
-0,5
-1,0
-1,5
-2,0
-2,5
-3,0
Q2 2006
Q3 2006
Q4 2006
Q1 2007
Q2 2007
Q3 2007
Q4 2007
© Statistisches Bundesamt (Federal Statistical Office, Germany), Price and volume measurement
27.07.2016
Folie 10
Results (2)
Development of hospital services
Year on year comparison, percentage
Year
Value
Price
Volume
2006
2.8
1.8
1.0
2007
…
-2.3
…
© Statistisches Bundesamt (Federal Statistical Office, Germany), Price and volume measurement
27.07.2016
Folie 11
Conclusion
From 2005 price and volume measures for hospitals
(except psychiatric and rehabilitation hospitals)
is based on DRG-data

Method: deflation and not volume measure


Data earlier available
Quarterly accounts possible

Stratification: 27 major diagnostic categories (MDC)
 Weights: Number of treatments for each MDC (yearly)
 Price development: calculated average prices for MDC
(yearly, quarterly)


Influence of about 1000 DRGs
- number of treatments - cost weights
Change of hospitals reference prices (base rate)
© Statistisches Bundesamt (Federal Statistical Office, Germany), Price and volume measurement
27.07.2016
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Thank you for your attention
Liane Ritter
Statistisches Bundesamt, Wiesbaden
Phone: +49 (0)611 / 75-2270
E-mail: liane.ritter@destatis.de
© Statistisches Bundesamt (Federal Statistical Office, Germany), Price and volume measurement