Die Sozial- und Bildungspolitik der Bush Administration. Andreas Falke. Springer VS: Wiesbaden, Eine erste Bilanz. R egionen und Regionalismus in den internationalen Beziehungen. Wissenschaftlicher Verlag, Die entfesselte Exekutive. Die Krise des liberalen Legalismus. Neue Ungleichheiten in den USA. New Inequalities in the United States"]. American Economies. Obamas Gesundheitsreform und der Kongress.
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Staat, Nation, Demokratie. First, DBC coding starts at the initial visit to a consultant while other systems code after hospital discharge. Second, a DRG classification usually consists of several hundreds groups, while the DBC system includes several thousand combinations. Third, the design of the DBC system covers the entire period of medical care, from consultant outpatient visits to inpatient episodes to rehabilitative care. During this period, the University Hospital of Maastricht conducted a feasibility study to test an adapted DRG system.
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Researchers visited the Yale University group and returned with the idea of testing DRGs in their home country. At the same time as the United States Medicare programme was implementing DRGs, initial pilot tests were being performed in the three countries. However, the momentum slowed down after the first pilots as the result of massive opposition among providers the Netherlands or poor applicability and missing prerequisites Germany and Switzerland.
Thereafter, and again in all three countries, DRGs fell off the policy agenda for nearly a decade, only returning with the introduction of major structural reforms. The attempt to introduce market principles on the paying side also affected perceptions of the way in which the provider side might operate. In the years that followed, there was a significant political consensus in support of increasing market competition in the hospital sector.
The experience of the three countries illustrates both that there was widespread support for the idea of implementing DRG systems and that intense learning from foreign as well as own experience took place. However, it also shows that DRGs were not simply transferred from one country to another — they had to be tailored to the specific framework of the country that was seeking to introduce them. DRGs had to take into account the interests of dominant national actors. Germany and Switzerland exemplify a compromise between provider interests and the interests of government and financing bodies.
Moreover, international organizations, including the OECD, WHO and the World Bank, provide information on various aspects of health care systems and serve as platforms for knowledge exchange.
Through analysing the implementation of DRGs in Germany, Switzerland, and the Netherlands, we have shown how the relevant actor learnt from foreign experience, but we have also shown how it was not until a regulatory framework for competition between sickness funds was introduced that DRGs came fully onto the political agenda. A change in the context of reforms — the introduction of regulated competition into the health care system — made DRGs a promising policy option.
All three cases show that policies are not merely emulated. Germany and Switzerland selected a DRG system that took into account the interests of the financing side as well as the delivery side to secure its implementation. Furthermore, both countries emphasized that the DRG system that they selected should permit them to make their own additions and alterations to it. They did not want to be tied to a licensed commercial product. The manner in which Germany developed its system of DRGs from the Australian model and, then, as Switzerland developed its system from the German model, are examples of instrumental learning.
The strikingly similar political strategies to engage and control stakeholders that were employed by the German and later the Swiss governments might well be counted as instances of strategic learning. Our study also shows that, with respect to the introduction of DRGs, politics played only a limited role. DRGs fitted into this approach.
Moreover, once the political decision had been made, implementation was largely a technical matter. It involved experts and managers. DRGs are not regarded an issue on which these bodies compete for support or attention. On the assumption that, because they are perceived to have less ideological baggage and, so, diffuse more easily across countries, we suggest that it would be useful to look at learning and transfer with respect some other of the more technical policies that, like DRGs, have been components of health care reforms.
We point to reference pricing, to risk adjustment schemes, and even to recent advances in health technology assessment. Volume 62 , Issue 4. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account. If the address matches an existing account you will receive an email with instructions to retrieve your username. Free Access.
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The diffusion of Diagnosis Related Groups and the interests of relevant actors DRGs aim to define hospital services as analogous to commercial products and serve to inform decisions about hospital funding, management, planning, and utilization review Rodrigues, Source: OECD ; own calculations. The Netherlands In the search for new policy tools, a delegation of the Dutch Ministry of Health visited the Yale University group in the late s.
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