The GAP-DRG Model: Simulation of outpatient care for comparison of different reimbursement schemes

Abstract

In health care the reimbursement of medical providers is an important topic and can influence the overall outcome. We present the agent-based GAP-DRG model, which allows a comparison of reimbursement schemes in outpatient care. It models patients and medical providers as agents. In the simulation patients develop medical problems (i.e., diseases) and a need for medical services. This leads to utilization of medical providers. The reimbursement system receives information on the patients´ visits via its generic interface, which facilitates an easy replacement. We describe the assumptions of the model in detail and show how it makes extensive use of available Austrian routine care data for its parameterization. The model design is optimized for utilizing as much of these data as possible. However, many assumptions have to be simplifications. Further work and detailed comparisons with health care data will provide insight on which assumptions are valid descriptions of the real process.