Gaming the Payment System: Evidence from Geriatric Rehabilitation
S.A.S. Verbunt (TU Delft - Technology, Policy and Management)
Naomi Van Van Der Linden – Mentor (TU Delft - Policy Analysis)
M Kroesen – Graduation committee member (TU Delft - Transport and Logistics)
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Abstract
The reimbursement scheme in geriatric rehabilitation (GR) contains stepwise tariffs depending on both the length of stay and treatment intensity: after a pre-determined number of inpatient days or treatment hours, the total reimbursement jumps to a higher level and then stays constant until the next threshold is reached. These discontinuous reimbursements may distort physicians’ behaviour in a way that is detrimental to the efficiency of care provision. This thesis examines whether these behavioural distortions are present regarding GR and, if so, which factors are associated with stronger distortions on a GR provider level. For this goal, GR claims data from health insurer CZ covering the years 2017–2023 are used. Furthermore, this thesis qualitatively assesses the possible consequences of the proposed changes in the payment system of GR, including the abolition of the current stepwise tariffs, using insights from GR claims data and economic theory.