Economic Impact of the Evolution of the National Reimbursement Rates: a 6-Year Modelization in a French ICU

Abstract

Purpose : Hospital funding for the intensive care unit (ICU) stays in France is made of reimbursement of a fixed amount based on the diagnosis-related group (DRG) of the patients and of extra funding for each day spent in the ICU. These tariffs are updated annually. We measured the impact of these updates on the theoretical income of our ICU.

Patients and Methods : DRG and length of stay of the patients hospitalized during 2011 in a 12-bed ICU were extracted. We computed the theoretical reimbursement for these patients with the tariffs from 2011 to 2016.

Results : 592 ICU stays, classified in 237 DRGs, were analyzed. The theoretical income decreased from € 8,416,260.14 in 2011 to € 7,809,709.15 in 2016 (–7.21%). This reduction was explained by lower tariffs for the different DRGs (mean evolution –4.6%) and a diminution of the extra funding (–1.6%).

Conclusion : These results are based on a small number of ICU stays but are significant because of the high number of DRGs analyzed.

This simulation gives an estimate of the economic impact on the French ICUs for the update of the reimbursement rates during the last six years. Productivity gains are necessary to face the tariff evolution and should preferably be obtained by the reduction of the costs.