Tuesday, April 16, 2024

Bundled Payment for Care Improvement vs Fee-for-Service in Brazil

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The effectiveness of the Bundled Payment for Care Improvement (BPCI) versus fee-for-service (FFS) was examined through a systematic review and meta-analysis. In Brazil, healthcare services are typically charged under a FFS payment system, where each medical procedure incurs a separate cost. An alternative payment method, diagnosis-related group (DRG) remuneration, covers all patient care under a set fee.

The review strictly adhered to the PRISMA report guidelines and only observational trials were included. The primary outcome studied was the effectiveness of FFS and DRG in appendectomy, considering complications. In addition, the costs and length of hospital stay were evaluated. The meta-analysis was conducted with Rev Man version 5.4.

Care Improvement

Impact of the DRG Model on Hospital Stay and Readmission Rates for Care Improvement

Of the 735 initially identified articles, six met the eligibility criteria. The results showed a shorter hospital stay linked with the DRG model (mean difference = 0.39; 95% confidence interval – 95%CI – 0.38-0.40; p < 0.00001; I2 = 0%). However, the hospital readmission rate was found to be higher with this model (odds ratio = 1.57; 95%CI 1.02-2.44, p = 0.04; I2 = 90%).

The study reveals that the DRG approach could potentially reduce the length of stay for appendectomy patients. However, no significant differences were observed in other outcome analyses between the two approaches.


Original Article DOI: 10.1590/acb386923

Original title: Comparing financing models for supplementary healthcare in appendectomy: activity-based costing (fee-for-service) vs. diagnosis related group remuneration (bundled payment) – a systematic review and meta-analysis

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