Detecting dishonest behavior in medical decision-making: Evidence from a lab experiment on DRG upcoding in neonatology
نویسندگان
چکیده
Prospective payments systems (diagnosis-related groups, DRG) to reimburse hospital inpatient care became very popular two decades ago (Ellis and McGuire, 1993). DRGs, however, may incentivize dishonest provider behavior, like inappropriately early discharge of patients, withholding of (necessary) diagnostics and therapies, cream-skimming of low-cost patients or coding of patients into groups with higher reimbursement, so-called DRG upcoding. DRG systems provide a strong financial incentive for dishonest behavior (e.g. Silvermann and Skinner 2004).
منابع مشابه
What explains DRG upcoding in neonatology? The roles of financial incentives and infant health.
We use the introduction of diagnosis related groups (DRGs) in German neonatology to study the determinants of upcoding. Since 2003, reimbursement is based inter alia on birth weight, with substantial discontinuities at eight thresholds. These discontinuities create incentives to upcode preterm infants into classes of lower birth weight. Using data from the German birth statistics 1996-2010 and ...
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