{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:52:52Z","timestamp":1790743972818,"version":"4.1.0"},"reference-count":22,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2013,1,18]],"date-time":"2013-01-18T00:00:00Z","timestamp":1358467200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2013,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Researchers from 11 countries (Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) compared how their Diagnosis\u2010Related Group (DRG) systems deal with knee replacement cases. The study aims to assist knee surgeons and national authorities to optimize the grouping algorithm of their DRG systems.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>National or regional databases were used to identify hospital cases treated with a procedure of knee replacement. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that together comprised at least 97 % of cases. Five standardized case scenarios were defined and quasi\u2010prices according to national DRG\u2010based hospital payment systems ascertained.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Grouping algorithms for knee replacement vary widely across countries: they classify cases according to different variables (between one and five classification variables) into diverging numbers of DRGs (between one and five DRGs). Even the most expensive DRGs generally have a cost index below 2.00, implying that grouping algorithms do not adequately account for cases that are more than twice as costly as the index DRG. Quasi\u2010prices for the most complex case vary between \u20ac4,920\u00a0in Estonia and \u20ac14,081\u00a0in Spain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Most European DRG systems were observed to insufficiently consider the most important determinants of resource consumption. Several countries\u2019 DRG system might be improved through the introduction of classification variables for revision of knee replacement or for the presence of complications or comorbidities. Ultimately, this would contribute to assuring adequate performance comparisons and fair hospital reimbursement on the basis of DRGs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Retrospective comparative study, Level III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-013-2374-6","type":"journal-article","created":{"date-parts":[[2013,1,17]],"date-time":"2013-01-17T06:22:42Z","timestamp":1358403762000},"page":"2548-2556","source":"Crossref","is-referenced-by-count":11,"title":["Knee replacement and Diagnosis\u2010Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries"],"prefix":"10.1002","volume":"21","author":[{"given":"Siok Swan","family":"Tan","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Institute for Medical Technology Assessment Erasmus Universiteit Rotterdam P. O. Box 1738 3000 DR Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Chiarello","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Servei d\u2032Epidemiologia i Avaluaci\u00f3 \u2010 Parc de Salut Mar (PSMAR) Hospital del Mar Passeig mar\u00edtim, 25\u201029 08003 Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilm","family":"Quentin","sequence":"additional","affiliation":[{"name":"<!--<label>3<\/label>--> Department of Health Care Management Technische Universit\u00e4t Berlin Stra\u00dfe des 17. Juni 135 10623 Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,1,18]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006416\u2010200505000\u201000003"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2005.04.021"},{"key":"e_1_2_7_4_2","first-page":"1","volume-title":"Diagnosis\u2010Related Groups in Europe: moving towards transparency, efficiency and quality in hospitals","author":"Busse R","year":"2011"},{"key":"e_1_2_7_5_2","unstructured":"Casemix Service(2008)HRG 4 design concepts.The Information Centre National Health Service (NHS) Leeds pp1\u201342"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/hec.2838"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0168\u20108510(99)00074\u20103"},{"key":"e_1_2_7_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00402\u2010008\u20100570\u20105"},{"key":"e_1_2_7_9_2","unstructured":"InEK(2011)Vorschlagsverfahren zur Einbindung des medizinischen wissenschaftlichen und weiteren Sachverstandes bei der Weiterentwicklung des G\u2010DRG\u2010Systems f\u00fcr das Jahr 2012.Institut f\u00fcr das Entgeldsystem im Krankenhaus (InEK) Siegburg pp1\u20139"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511620003"},{"key":"e_1_2_7_11_2","first-page":"1","volume-title":"Hospital data project phase 2: final report. 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