Competition under different reimbursement systems: The concept of an internet-based hospital management game Marion S. Rauner a, * , Markus Kraus b , Sigrun Schwarz c a University of Vienna, School of Business, Economics and Statistics, Department of Innovation and Technology Management, Bruenner Str. 72, A-1210 Vienna, Austria b Institute for Advanced Studies, Stumpergasse 56, A-1060 Vienna, Austria c University of Applied Sciences Muenster, Department of Nursing, Leonardo Campus 8, D-48149 Muenster, Germany Received 1 April 2005; accepted 1 February 2006 Available online 12 October 2006 Abstract We have developed an internet-based management game to illustrate the economic and organisational decision-making process in a hospital by using discrete event simulation. Up to six hospitals compete against each other for inpatients with different disease categories and budget depending on hospital mission, regional health policy, inpatient reimbursement sys- tem (day-, case- and global-budget based) as well as labour and radiology technology market for 12 decision periods. Play- ers can evaluate alternative actions for capacity planning as well as patient scheduling and control problems depending on different game situations. The uniqueness of COREmain hospital game consists of the internet-based framework, the com- bination of resource, process and financial result management, the competition of hospitals within a region and the con- sideration of different inpatient reimbursement systems. The deployment of this game in teaching, policy and research might improve policy making both at a hospital, regional and national level and also induce further research in these fields. Ó 2006 Elsevier B.V. All rights reserved. Keywords: Internet-based hospital management game; Competing hospitals; Reimbursement systems; Decision support system; OR in health services; Simulation 1. Introduction Soaring costs and reduced revenues characterise the situation in the health care systems in many countries. On average, the EU-15 countries spent 8.6% or US-$ 2278 per capita and the USA spent 13.9% or US-$ 3248 per capita (adjusted, using pur- chasing power parities) of its gross domestic prod- uct (GDP) for health care in 2001 (Hofmarcher et al., 2004). More than 40% of the health care costs are consumed for hospitals in industrialised coun- tries. Expensive or ‘‘big ticket’’ medical technologies (BTTs) for the diagnosis and treatment of certain clinical conditions (e.g., computer tomography scanners – CTs, magnetic resonance imaging devices – MRIs) were disclosed as contributing factors to 0377-2217/$ - see front matter Ó 2006 Elsevier B.V. All rights reserved. doi:10.1016/j.ejor.2006.02.055 * Corresponding author. Tel.: +43 1 4277 38150; fax: +43 1 4277 38144. E-mail addresses: marion.rauner@univie.ac.at (M.S. Rauner), markus-kraus@aon.at (M. Kraus), sschwarz@fh-muenster.de (S. Schwarz). URL: http://www.univie.ac.at/bwl/itm/staff/rauner.htm (M.S. Rauner). European Journal of Operational Research 185 (2008) 948–963 www.elsevier.com/locate/ejor