Reimbursement policies, incentives and disincentives to perform laparoscopic surgery in Israel

The introduction of laparoscopic surgery was believed to bestow great advan tages to patients and health services. Health services and societal costs m ay also be affected bq changes in length of hospital stay, operating room c osts: and return to normal activity. The aim of this paper is to examine th e influence of two different reimbursement methods: (per diem and DRG) on t he incentives and disincentives given to different role players in the Isra eli health-care system regarding two common surgical procedures: appendecto my and inguinal hernia repair. Three different perspectives are discussed: society, the hospitals and the sick funds. From the hospital's perspective. laparoscopic surgery is usually more expensive compared to open procedures . mainly due to higher operating room costs. We suggest that as far as curr ent reimbursement methods are preserved. hospitals have no economic incenti ve to adopt the laparoscopic technology as benefits occur only to society. In general, sick funds would encourage hospitals to perform laparoscopic ap pendectomy. where the payment is per diem and would be economically indiffe rent regarding laparoscopic inguinal hernia repair. where hospitals are com pensated on a DRG basis. It has been suggested that economic advantages to society may arise from a faster return to work after laparoscopic appendect omy and laparoscopic inguinal hernia repair. In this case, new payment arra ngements should be set to give proper incentives for the adoption of laparo scopic procedures. (C) 2001 Elsevier Science Ireland Ltd. All rights reserv ed.