Upcoding in a NHS

Universidade de Évora
Colégio Espírito Santo - Sala 124

25/05/2012 04:00 pm

Pedro Pita Barros (Universidade Nova de Lisboa)

Resumo/Abstract: Evidence from the US pointed out, over the years, to the existence of upcoding in management practices. Upcoding is dened as classifying patients in DRG codes associated with larger payments. The incentive for upcoding is not particular to private providers of care. Conceptually, any patient classication system that is used for payment purposes may be vulnerable to this sort of strategic behavior by providers. We document here that upcoding can also be present in a National Health Service where public, Government-owned and managed, hospitals have their payment (budget) tied to the classication of treatment episodes. Using DRG data from Portugal we nd that upcoding is being used by hospitals to increased their budgets.

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