Coordination of patients between specialist- and primary care An explorative study of hospitals´ invoicing practices in the wake of introduction of municipal co-financing

Abstract

Coordination of patients between specialist- and primary care - An explorative study of hospitals´ invoicing practices in the wake of introduction of municipal co-financing Background. As a response to overarching challenges of cost containment, prevention of disease, demographic changes and the patient´s need for coordinated health care services, The Coordination reform, Report No. 47 (2008-2009) was implemented in 2012. The reform introduced strong economic incentives, legal means and organizational instruments in order to improve coordination between two levels of care. The municipalities were made responsible for the patients ready for discharge and a payment regulation were introduced. The responsibility to bill the municipalities on proper grounds rests with the individual hospitals. Statistics show that they do not claim economic reimbursement to cover for all the services given the municipalities The aim for the study was to explain invoice issues by structural and organizational dimensions in the discharge process. How the coordination model and the instruments introduced by the Coordination reform are can explain invoice issues are also discussed. Method. This qualitative study is based primarily on seven semi-structured interviews and document analysis. Respondents from hospital and municipalities have been interviewed. Conclusions This study has demonstrated that the overall economic implication of the payment regulation in the hospital is insignificant. However, the economic incentive keeps the attention high at both specialist and primary level of care. Both levels spend relatively much time and effort on the administration and control of these funds. Successful planning of patient discharge is a prerequisite in order to invoice the municipalities without errors. However, the instruments introduced by the Coordination reform serve as mechanisms in an asymmetric relation between specialist and primary care and creates challenges for a successful transfer of patients between the two levels of care.