ISSUE: Austria was amongst the first European countries introducing a DRG-based hospital payment system in 1997. Initially, the groups were based on 476 diagnoses related groups for non-surgical admissions and 374 procedure related groups. The DRGs are granted for any case between a distinct range of the length of stay. *** DESCRIPTION OF THE PROBLEM: While intended to decrease average length of stay (ALOS) as well as hospitalisation rates, Austria only experienced decreasing ALOS in the first 10 years of the DRG-system from 8.3 days in 1997 to 6.8 days in 2007. Hospitalisation rates, however, continued to increase from 23 discharges per 100 inhabitants to 26.1 discharges in 2007 albeit initial high rates. Overall, concerns on the effectiveness of DRGs as an appropriate payment system increased amongst policy makers resulting in an evaluation ten years after its introduction. *** RESULTS:
Even though the evaluation did not propose any immediate measures it increased the awareness of actively adapting the DRG system as well as capacity planning in order to provide the right incentives. In 2006, the regions were put in charge of detailed capacity planning at hospitals level making them accountable for structural health reforms. Day cases were increasingly incentivised in the DRG system and with the health reform 2013 thresholds were set up as minimum day case rates for various procedures. The 2013 reform brought also the development of a DRG system for ambulant services provided in hospital outpatient clinics. Overall, hospitalisation rates started to decrease from 2008 onwards from 26.3 discharges to 23 discharges in 2016 per 100 inhabitants. *** LESSONS: Although effective with regard to reducing ALOS DRG-based hospital payment systems do not necessarily promote lower hospitalisation rates. For the Austrian case with a high density of hospitals beds joint effort with regard to capacity planning and permanent adjustment of the DRG-system were necessary to reduce hospital admissions.