Day surgery-International experiences, remuneration systems and financial incentives in England, France and Austria

Background: Ambulatory surgery or day surgery (admission, surgery and discharge on the same day) has become increasingly more important internationally. Nevertheless, there are large differences in the proportion of day surgery interventions between countries.Objective: Investigation of the healthcare policy development of day surgery and the impact of remuneration systems and financial incentives on the shift of service provision from inpatient to day surgery, using England, France, and Austria as examples.Methods: This is based on structured research of national documentation of service catalogues and tariff systems as well as reports of professional societies in the field of day surgery, supplemented by literature searches in medical bibliographic databases and by expert interviews.Results: Diagnosis-related groups (DRG) systems are used to remunerate hospitals in all three countries. In England and France, the remuneration of day surgery is integrated into a common DRG system. In Austria, an ambulatory DRG system was introduced in 2019. Best practice tariffs (BPT) in England introduced higher tariffs for day surgery, which were effective in shifting service provision. In France, uniform tariffs were particularly effective in public hospitals.Conclusion: The potentially positive effects of financial incentives on shifting of services to day care can be strengthened or weakened by nonfinancial aspects. The international experiences can give Germany an important impulse for the further development and implementation of an already existing remuneration concept of intersectoral equality.