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Hospital accreditation, reimbursement and case mix: Links and insights for contractual systems

Show simple item record Ammar W. Khalife J. El-Jardali F. Romanos J. Harb H. Hamadeh G. Dimassi H.
dc.contributor.editor Dec-2013 2017-10-18T13:35:50Z 2017-10-18T13:35:50Z 2013
dc.identifier 10.1186/1472-6963-13-505
dc.identifier.issn 14726963
dc.description.abstract Background: Resource consumption is a widely used proxy for severity of illness, and is often measured through a case-mix index (CMI) based on Diagnosis Related Groups (DRGs), which is commonly linked to payment. For countries that do not have DRGs it has been suggested to use CMIs derived from International Classification of Diseases (ICD). Our research objective was to use ICD-derived case-mix to evaluate whether or not the current accreditation-based hospital reimbursement system in Lebanon is appropriate. Methods. Our study population included medical admissions to 122 hospitals contracted with the Lebanese Ministry of Public Health (MoPH) between June 2011 and May 2012. Applying ICD-derived CMI on principal diagnosis cost (CMI-ICDC) using weighing similar to that used in Medicare DRG CMI, analyses were made by hospital accreditation, ownership and size. We examined two measures of 30-day re-admission rate. Further analysis was done to examine correlation between principal diagnosis CMI and surgical procedure cost CMI (CMI-CPTC), and three proxy measures on surgical complexity, case complexity and surgical proportion. Results: Hospitals belonging to the highest accreditation category had a higher CMI than others, but no difference was found in CMI among the three other categories. Private hospitals had a higher CMI than public hospitals, and those more than 100 beds had a higher CMI than smaller hospitals. Re-admissions rates were higher in accreditation category C hospitals than category D hospitals. CMI-ICDC was fairly correlated with CMI-CPTC, and somehow correlated with the proposed proxies. Conclusions: Our results indicate that the current link between accreditation and reimbursement rate is not appropriate, and leads to unfairness and inefficiency in the system. Some proxy measures are correlated with case-mix but are not good substitutes for it. Policy implications of our findings propose the necessity for changing the current reimbursement system by including case mix and outcome indicators in addition to accreditation in hospital contracting. Proxies developed may be used to detect miss-use and provider adverse behavior. Research using ICD-derived case mix is limited and our findings may be useful to inform similar initiatives and other limited-setting countries in the region. © 2013 Ammar et al.; licensee BioMed Central Ltd.
dc.language English
dc.publisher BioMed Central Ltd.; LONDON
dc.relation.ispartof Publication Name: BMC Health Services Research; Publication Year: 2013; Volume: 13; no. 1;
dc.source Scopus
dc.title Hospital accreditation, reimbursement and case mix: Links and insights for contractual systems
dc.type Article
dc.contributor.affiliation Ammar, W., Department of Health Management and Policy, American University of Beirut, Ministry of Public Health, Beirut, Lebanon
dc.contributor.affiliation Khalife, J., Emergency Social Protection Implementation Support Project, Ministry of Public Health, Beirut, Lebanon
dc.contributor.affiliation El-Jardali, F., Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
dc.contributor.affiliation Romanos, J., Department of Information Technology, Ministry of Public Health, Beirut, Lebanon
dc.contributor.affiliation Harb, H., Department of Statistics, Ministry of Public Health, Beirut, Lebanon
dc.contributor.affiliation Hamadeh, G., Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
dc.contributor.affiliation Dimassi, H., School of Pharmacy, Lebanese American University, Beirut, Lebanon
dc.contributor.authorAddress Khalife, J.; Emergency Social Protection Implementation Support Project, Ministry of Public Health, Beirut, Lebanon; email:
dc.contributor.authorCorporate University: American University of Beirut; Faculty: Faculty of Health Sciences; Department: Health Management and Policy;
dc.contributor.authorDepartment Health Management and Policy
dc.contributor.faculty Faculty of Health Sciences
dc.contributor.authorInitials Ammar, W
dc.contributor.authorInitials Khalife, J
dc.contributor.authorInitials El-Jardali, F
dc.contributor.authorInitials Romanos, J
dc.contributor.authorInitials Harb, H
dc.contributor.authorInitials Hamadeh, G
dc.contributor.authorInitials Dimassi, H
dc.contributor.authorReprintAddress Khalife, J (reprint author), Minist Publ Hlth, Emergency Social Protect Implementat Support Proj, Beirut, Lebanon.
dc.contributor.authorUniversity American University of Beirut
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dc.description.citedTotWOSCount 0
dc.description.citedWOSCount 0
dc.format.extentCount 1
dc.identifier.articleNo 505
dc.identifier.pubmedID 24308304
dc.identifier.scopusID 84889078236
dc.publisher.address 236 GRAYS INN RD, FLOOR 6, LONDON WC1X 8HL, ENGLAND
dc.relation.ispartOfISOAbbr BMC Health Serv. Res.
dc.relation.ispartOfIssue 1
dc.relation.ispartofPubTitle BMC Health Services Research
dc.relation.ispartofPubTitleAbbr BMC Health Serv. Res.
dc.relation.ispartOfVolume 13
dc.source.ID WOS:000329371700002
dc.type.publication Journal
dc.subject.otherAuthKeyword Accreditation
dc.subject.otherAuthKeyword Case mix
dc.subject.otherAuthKeyword Contracting
dc.subject.otherAuthKeyword Healthcare utilization
dc.subject.otherAuthKeyword Icd10
dc.subject.otherAuthKeyword Lebanon
dc.subject.otherAuthKeyword Middle income
dc.subject.otherAuthKeyword Payment mechanism
dc.subject.otherAuthKeyword Readmission
dc.subject.otherIndex accreditation
dc.subject.otherIndex article
dc.subject.otherIndex diagnosis related group
dc.subject.otherIndex economics
dc.subject.otherIndex financial management
dc.subject.otherIndex health economics
dc.subject.otherIndex hospital readmission
dc.subject.otherIndex human
dc.subject.otherIndex Lebanon
dc.subject.otherIndex organization and management
dc.subject.otherIndex private hospital
dc.subject.otherIndex reimbursement
dc.subject.otherIndex statistics
dc.subject.otherIndex Accreditation
dc.subject.otherIndex Contract Services
dc.subject.otherIndex Diagnosis-Related Groups
dc.subject.otherIndex Economics, Hospital
dc.subject.otherIndex Hospitals, Private
dc.subject.otherIndex Humans
dc.subject.otherIndex Insurance, Health, Reimbursement
dc.subject.otherIndex Lebanon
dc.subject.otherIndex Patient Readmission
dc.subject.otherIndex Reimbursement Mechanisms
dc.subject.otherKeywordPlus REFORM FOLLOWS FAILURE
dc.subject.otherKeywordPlus QUALITY-OF-CARE
dc.subject.otherKeywordPlus INTENSIVE-CARE
dc.subject.otherKeywordPlus PERFORMANCE
dc.subject.otherKeywordPlus PAY
dc.subject.otherKeywordPlus READMISSION
dc.subject.otherKeywordPlus IMPROVEMENT
dc.subject.otherKeywordPlus LEBANON
dc.subject.otherKeywordPlus RISK
dc.subject.otherWOS Health Care Sciences and Services

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