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The reimbursement of new medical technologies in German inpatient care: What factors explain which hospitals receive innovation payments?

Published online by Cambridge University Press:  04 June 2019

Patricia Ex ,
Verena Vogt ,
Reinhard Busse  and
Cornelia Henschke
Patricia Ex*
Affiliation:
TU Berlin, Department of Health Care Management, Technische Universität Berlin, 10623Berlin, Germany
Verena Vogt
Affiliation:
TU Berlin, Department of Health Care Management, Technische Universität Berlin, 10623Berlin, Germany
Reinhard Busse
Affiliation:
TU Berlin, Department of Health Care Management, Technische Universität Berlin, 10623Berlin, Germany
Cornelia Henschke
Affiliation:
TU Berlin, Department of Health Care Management, Technische Universität Berlin, 10623Berlin, Germany
*
*Correspondence to. Email: [email protected]
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Abstract

Most hospital payment systems based on diagnosis-related groups (DRGs) provide payments for newly approved technologies. In Germany, they are negotiated between individual hospitals and health insurances. The aim of our study is to assess the functioning of temporary reimbursement mechanisms. We used multilevel logistic regression to examine factors at the hospital and state levels that are associated with agreeing innovation payments. Dependent variable was whether or not a hospital had successfully negotiated innovation payments in 2013 (n = 1532). Using agreement data of the yearly budget negotiations between each German hospital and representatives of the health insurances, the study comprises all German acute hospitals and innovation payments on all diagnoses. In total, 32.9% of the hospitals successfully negotiated innovation payments in 2013. We found that the chance of receiving innovation payments increased if the hospital was located in areas with a high degree of competition and if they were large, had university status and were private for-profit entities. Our study shows an implicit self-controlled selection of hospitals receiving innovation payments. While implicitly encouraging safety of patient care, policy makers should favour a more direct and transparent process of distributing innovation payments in prospective payment systems.

Keywords

Adjustment of DRG systemhospital financinginnovation paymentsreimbursement of new medical technologiestechnological innovation

JEL classification

C30: General D78: Positive Analysis of Policy Formulation and Implementation H51: Government Expenditures and Health J11: Demographic Trends, Macroeconomic Effects, and Forecasts O33: Technological Change: Choices and Consequences • Diffusion Processes
Type
Articles
Information
Health Economics, Policy and Law , Volume 15 , Issue 3 , July 2020 , pp. 355 - 369
Copyright
Copyright © Cambridge University Press 2019

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References

Altenstetter, C (1996) Regulating healthcare technologies and medical supplies in the European Economic Area. Health Policy 35, 33–52.CrossRefGoogle ScholarPubMed
Augurzky, B, Pilny, A and Wübker, A (2015) Krankenhäuser in privater Trägerschaft 2015. RWI 89. Essen: RWI.Google Scholar
Banaszak-Holl, J, Zinn, S and Mor, V (1996) The impact of market and organizational characteristics on nursing care facility service innovation: a resource dependency perspective. Health Services Research 31, 97–117.Google ScholarPubMed
Bäumler, M (2013) Which non-clinical factors influence the use of innovative implants? The example of drug-releasing coronary stents in patients with acute myocardial infarction: a multilevel regression analysis. Das Gesundheitswesen 75, 822–831.Google ScholarPubMed
Bech, M, Christiansen, T, Dunham, K, Lauridsen, J, Lyttkens, CH, McDonald, K and McGuire, A (2009) The influence of economic incentives and regulatory factors on the adoption of treatment technologies: a case study of technologies used to treat heart attacks. Health Economics 18, 1114–1132. Available online at doi:10.1002/hec.1417CrossRefGoogle ScholarPubMed
Black, W (1990) The CE plane: a graphic representation of cost-effectiveness. Medical Decision Making 10, 212–214.CrossRefGoogle ScholarPubMed
Blank, J and Valdmanis, VG (2015) Technology diffusion in hospitals: a log odds random effects regression model. The International Journal of Health Planning and Management 30, 246–259.CrossRefGoogle ScholarPubMed
Blum, K and Offermanns, M (2009) Anspruch und Realität von Budgetverhandlungen zur Umsetzung medizintechnischer Innovationen: Gutachten des Deutschen Krankenhausinstituts im Auftrag des Bundesverbandes Medizintechnologie. Unpublished manuscript, last modified January 2016. Available online at https://www.bvmed.de/download/gutachten-innovationstransfer-nub.pdfGoogle Scholar
Bölt, U and Graf, T (2012) 20 Jahre Krankenhausstatistik. Statistisches Bundesamt, Wirtschaft und Statistik.Google Scholar
Bonastre, J, Chevalier, J, van der Laan, C, Delibes, M and de Pouvourville, G (2014) Access to innovation: is there a difference in the use of expensive anticancer drugs between French hospitals? Health Policy 116, 162–169.CrossRefGoogle Scholar
Callea, G, Cavallo, MC, Tarricone, R and Torbica, A (2017) Learning effect and diffusion of innovative medical devices: the case of transcatheter aortic valve implantation in Italy. Journal of Comparative Effectiveness Research 6, 279–292.CrossRefGoogle ScholarPubMed
Castro, MF, Calogero, G, Pignataro, G and Rizzo, I (2014) The effects of reimbursement mechanisms on medical technology diffusion in the hospital sector in the Italian NHS. Health Policy 115, 215–229. Available online at doi:10.1016/j.healthpol.2013.12.004CrossRefGoogle Scholar
Cohen, J (2010) Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences, 3rd edn. [Nachdr.]. Mahwah, NJ: Erlbaum. Available online at http://reference-tree.com/book/applied-multiple-regression-correlation-analysis-for-the-behavioral-sciences?utm_source=gbv&utm_medium=referral&utm_campaign=collaborationGoogle Scholar
Daidone, S and D'Amico, F (2009) Technical efficiency, specialization and ownership form: evidences from a pooling of Italian hospitals. Journal of Productivity Analysis 32, 203–216.CrossRefGoogle Scholar
Dayhoff, DA and Cromwell, J (1993) Measuring differences and similarities in hospital caseloads: a conceptual and empirical analysis. Health Services Research 28, 293–312.Google ScholarPubMed
Drummond, M, Sculpher, M, Claxton, K, Stoddart, G and Torrance, GW (2015) Methods for the Economic Evaluation of Health Care Programmes, 4th edn.Oxford: Oxford Univ. Press.Google Scholar
Farley, DE and Hogan, C (1990) Case-mix specialization in the market for hospital services. Health Services Research 25, 757–783.Google ScholarPubMed
Federal Association of Statutory Health Insurance Funds (2016). Neue Untersuchungs- und Behandlungsmethoden (NUB). Available online at https://www.gkv-spitzenverband.de/krankenversicherung/krankenhaeuser/drg_system/neue_untersuchungs_und_behandlungsmethoden_nub/neue_untersuchungs_und_behandlungsmethoden_nub.jsp (Accessed 22 January 2016).Google Scholar
Greenhalgh, T, Robert, G, Macfarlane, F, Bate, P and Kyriakidou, O (2004) Diffusion of innovations in service organizations: systematic review and recommendations. The Milbank Quarterly 82, 581–629.CrossRefGoogle ScholarPubMed
Greer, AL (1985) Adoption of medical technology: the hospital's three decision systems. International Journal of Technology Assessment in Health Care 1, 669–680.CrossRefGoogle ScholarPubMed
Hatz, HM, Schreyögg, J, Torbica, A, Boriani, G and Blankart, CRB (2017) Adoption decisions for medical devices in the field of cardiology: results from a European survey. Health Economics 26(suppl. 1), 124–144.CrossRefGoogle ScholarPubMed
Henschke, C, Bäumler, M, Weid, S, Gaskins, M and Busse, R (2010) Extrabudgetary (‘NUB’) payments: a gateway for introducing new medical devices into the German inpatient reimbursement system? Journal of Management & Marketing in Healthcare 3, 119–133.CrossRefGoogle Scholar
Herwartz, H and Strumann, C (2012) On the effect of prospective payment on local hospital competition in Germany. Health Care Management Science 15, 48–62.CrossRefGoogle ScholarPubMed
Institut für das Entgeltsystem im Krankenhaus (2015) Verfahrenseckpunkte: Anfragen nach § 6 Abs. 2 KHEntgG (Neue Untersuchungs- und Behandlungsmethoden). Available online at http://www.g-drg.de/cms/Neue_Untersuchungs-_und_Behandlungsmethoden_NUB/Verfahrenseckpunkte (Accessed January 2016).Google Scholar
Kesteloot, K and Voet, N (1998) Incentives for cooperation in quality improvement among hospitals? The impact of the reimbursement system. Journal of Health Economics 17, 701–728.CrossRefGoogle ScholarPubMed
Kim, H-S, Kim, Y-H, Woo, J-S and Hyun, S-J (2015) An analysis of organizational performance based on hospital specialization level and strategy type. PLoS ONE 10, e0132257.CrossRefGoogle ScholarPubMed
Kimberly, JR and Evanisko, MJ (1981) Organizational innovation: the influence of individual, organizational, and contextual factors on hospital adoption of technological and administrative innovations. Academy of Management Journal 24, 689–713.Google ScholarPubMed
Klauber, J, Geraedts, M, Friedrich, J and Wasem, J (2015) Krankenhaus-Report 2015: Schwerpunkt Strukturwandel. Stuttgart: F.K. Schattauer.Google Scholar
Knieps, F (2009) Competition in healthcare – political intentions: [Wettbewerb im Gesundheitswesen – politische Intentionen]. Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen 103, 615–619; discussion 619–20.CrossRefGoogle Scholar
Lee, RH and Waldman, DM (1985) The diffusion of innovations in hospitals. Some econometric considerations. Journal of Health Economics 4, 373–380.CrossRefGoogle ScholarPubMed
Lettieri, E and Masella, C (2009) Priority setting for technology adoption at a hospital level: relevant issues from the literature. Health Policy 90, 81–88.CrossRefGoogle Scholar
Levaggi, R, Moretto, M and Pertile, P (2014) Two-part payments for the reimbursement of investments in health technologies. Health Policy 115, 230–236.CrossRefGoogle ScholarPubMed
Lindlbauer, I and Schreyögg, J (2014) The relationship between hospital specialization and hospital efficiency: do different measures of specialization lead to different results? Health Care Management Science 17, 365–378.CrossRefGoogle ScholarPubMed
Loskamp, N, Genett, T, Schaffer, D and Schulze-Ehring, F (2017) Medizinisch-technischer Fortschritt als Ergebnis des Systemwettbewerbs zwischen GKV und PKV: Die Rolle der privaten Krankenversicherung (PKV).Google Scholar
Martelli, N and van den Brink, H (2014) Special funding schemes for innovative medical devices in French hospitals: the pros and cons of two different approaches. Health Policy 117, 1–5.CrossRefGoogle ScholarPubMed
McCullough, JS (2008) The adoption of hospital information systems. Health Economics 17, 649–664.CrossRefGoogle ScholarPubMed
Mitchell, DG, Parker, L, Sunshine, JH and Levin, DC (2002) Body MR imaging and CT volume: variations and trends based on an analysis of Medicare and fee-for-service health insurance databases. AJR (American Journal of Roentgenology) 179, 27–31.CrossRefGoogle Scholar
Nolting, H-D, Zich, K, Deckenbach, B, Gottberg, A, Lottmann, K, Klemperer, D, Grote-Westrick, M and Schwenk, U (2011) Faktencheck Gesundheit: Regionale Unterschiede in der Gesundheitsversorgung. Gütersloh: Bertelsmann Stiftung.Google Scholar
Robinson, JC and Luft, HS (1985) The impact of hospital market structure on patient volume, average length of stay, and the cost of care. Journal of Health Economics 4, 333–356.CrossRefGoogle ScholarPubMed
Rogers, E (2003) Diffusion of Innovations, 5th edn. Free Press trade paperback edition. Social Science. New York, London, Toronto, Sydney: Free Press.Google Scholar
Romeo, AA, Wagner, JL and Lee, RH (1984) Prospective reimbursement and the diffusion of new technologies in hospitals. Journal of Health Economics 3, 1–24.CrossRefGoogle ScholarPubMed
Rye, CB and Kimberly, JR (2007) The adoption of innovations by provider organizations in health care. Medical Care Research and Review 64, 235–278.CrossRefGoogle ScholarPubMed
Sáenz-Royo, C, Gracia-Lázaro, C and Moreno, Y (2015) The role of the organization structure in the diffusion of innovations. PLoS ONE 10, e0126076.CrossRefGoogle ScholarPubMed
Scheller-Kreinsen, D, Quentin, W and Busse, R (2011) DRG-based hospital payment systems and technological innovation in 12 European countries. Value in Health 14, 1166–1172.CrossRefGoogle ScholarPubMed
Schmid, A and Ulrich, V (2012) Konzentration und Marktmacht bei Krankenhäusern [concentration and market power in the hospital sector]. Gesundh ökon Qual manag 17, 18–22.CrossRefGoogle Scholar
Schreyögg, J, Bäuml, M, Krämer, J, Dette, T, Busse, R and Geissler, A (2014) Forschungsauftrag zur Mengenentwicklung nach § 17b Abs. 9 KHG.Google Scholar
Sethi, RKV, Henry, AJ, Hevelone, ND, Lipsitz, SR, Belkin, M and Nguyen, LL (2013) Impact of hospital market competition on endovascular aneurysm repair adoption and outcomes. Journal of Vascular Surgery 58, 596–606.CrossRefGoogle ScholarPubMed
Sorenson, C and Drummond, M (2014) Improving medical device regulation: the United States and Europe in perspective. The Milbank Quarterly 92, 114–150.CrossRefGoogle Scholar
Sorenson, C and Kanavos, P (2011) Medical technology procurement in Europe: a cross-country comparison of current practice and policy. Health Policy 100, 43–50.CrossRefGoogle ScholarPubMed
Sorenson, C, Drummond, M and Wilkinson, G (2013) Use of innovation payments to encourage the adoption of new medical technologies in the English NHS. Health Policy and Technology 2, 168–173.CrossRefGoogle Scholar
Sorenson, C, Drummond, M, Torbica, A, Callea, G and Mateus, C (2015) The role of hospital payments in the adoption of new medical technologies: an international survey of current practice. Health Economics, Policy, and Law 10, 133–159.CrossRefGoogle ScholarPubMed
Tiemann, O and Schreyögg, J (2009) Effects of ownership on hospital efficiency in Germany. BuR Business Research Journal 2, 115–145.CrossRefGoogle Scholar
Tiemann, O, Schreyögg, J and Busse, R (2012) Hospital ownership and efficiency: a review of studies with particular focus on Germany. Health Policy 104, 163–171.CrossRefGoogle ScholarPubMed
Torbica, A and Cappellaro, G (2010) Uptake and diffusion of medical technology innovation in Europe: What role for funding and procurement policies? Journal of Medical Marketing 10, 61–69.CrossRefGoogle Scholar
Varabyova, Y, Blankart, CR, Greer, AL and Schreyögg, J (2017) The determinants of medical technology adoption in different decisional systems: a systematic literature review. Health Policy 121, 230–242.CrossRefGoogle ScholarPubMed
Weng, R-H, Huang, J-A, Kuo, Y-H, Huang, C-Y and Huang, Y-C (2011) Determinants of technological innovation and its effect on hospital performance. African Journal of Business Management 5, 4314–4327.Google Scholar
White, C, Reschovsky, JD and Bond, AM (2014) Understanding differences between high- and low-price hospitals: implications for efforts to rein in costs. Health Affairs (Project Hope) 33, 324–331.CrossRefGoogle ScholarPubMed
Wilke, M (2007) Studie: Stellenwert der Innovationsentgelte für Deutsche Krankenhäuser. Unpublished manuscript, last modified January 2016. Available online at webarchiv.medizincontroller.de/info/Studie_innovationsentgelte.pdfGoogle Scholar
Wilkinson, G and Drummond, M (2014) Impact of reimbursement policies on the adoption of medical devices in an outpatient setting. Health Policy and Technology 3, 281–286.CrossRefGoogle Scholar
Willemé, P and Dumont, M (2015) Machines that go ‘ping’: medical technology and health expenditures in OECD countries. Health Economics 24, 1027–1041.CrossRefGoogle ScholarPubMed
Zwanziger, J, Melnick, GA and Simonson, L (1996) Differentiation and specialization in the California Hospital Industry 1983 to 1988. Medical Care 34, 361–372.CrossRefGoogle ScholarPubMed