This article has been cited by other articles in PMC. To examine potential changes in quality of care associated with a recent financing system implementation in Italy: Regional population data were used to calculate rates.
Of these, increasing efficiency is the reason most closely linked to DRG-based payment systems and the rationale behind the introduction of such systems in former Soviet republics still grappling with a legacy of overcapacity in inpatient care, such as Estonia 14 and Kyrgyzstan.
Making hospital activity more transparent for purchasers and providers was an explicit objective in Poland 37 and Serbia. In Croatia, DRG-based payment is used to increase the number of cases seen and reduce waiting lists.
The DRG variant chosen by a country determines the number of case groups as well as the cost weights or range of cost weights used, yet country-specific adjustments, to be discussed in a subsequent section, may be required. Moreover, some countries switched from one variant to another or developed their DRG-based systems over time by making adjustments, such as generating more detailed and specific case groupings.
This dynamic developmental process of introducing and implementing DRGs appears to reflect improvements in administrative and operational capacity, i. Most of the low- and middle-income countries in this study use a DRG-based hospital payment system consisting of about to case groups.
Kyrgyzstan and Mongolia are exceptional in having a much lower number of case groups. In Kyrgyzstan case groups are broader and the classification system is less demanding, since the DRG-based payment system serves to provide hospitals with funding in addition to budget allocations.
The study of length of stay (LOS) outliers is important for the management and financing of hospitals. Our aim was to study variables associated with high LOS outliers and their evolution over time. We used hospital administrative data from inpatient episodes in public acute care hospitals in the Portuguese National Health Service (NHS), with . PRINCIPAL FINDINGS: The total number of ordinary hospital admissions decreased from , to , between and , a population-based decrease of percent (p. "Effect Of Drgs On Hospital Admissions And Length Of Stay" Essays and Research Papers Effect Of Drgs On Hospital Admissions And Length Of Stay relevant in the ICU and is .
On the other hand, Indonesia and Thailand have and case groups, respectively. A higher number of groups may reflect a more sophisticated health-care system that provides a greater variety of services.
On the other hand, fewer groups could also signify that the groupings are deliberately broader, which increases the need for efficient use of resources on the provider side.
Finally, only Kyrgyzstan 26 was found to apply adjustment factors to calibrate its payment system for different provider levels and for different regions. In addition, the country trialled a higher base rate at the regional level for patients who were exempted from formal co-payments.
Thus, establishing an explicit budget and setting volume ceilings are equally important in guiding hospital management. All countries for which information is available do indeed have a ceiling in place.
The purpose of volume or budget ceilings as a policy lever is to contain costs, but their effects can vary. In Hungary, for example, the negotiated volume levels decreased over the years and, as a result, waiting periods increased.
Flexible case volume allocations across hospitals depending on utilization rates within a global ceiling, such as in Romania, 39 are another possibility. Yet, the incentive for a hospital to increase its case volume remains.
In Thailand, on the other hand, the base rate varies in accordance with the overall number of cases to stay within the total budget. This applies primarily to cost weights but also to case grouping in the case of an imported system. Adaptation is needed because the cost structure of delivering acute care may vary considerably across countries, depending on their level of technology and the degree of labour applied.
If cost weights are inadequately adjusted, it may create the wrong incentives. Most countries have in fact undertaken some adjustment of cost weights to their country context.
For example, Kyrgyzstan 26 and Poland 37 used the costing data that were available before the introduction of the DRG-based system for their case weight adjustment. In Croatia, costing studies were conducted for this purpose, 11 whereas The former Yugoslav Republic of Macedonia took the cost weights from Croatia 47 and adjusted them to its own context.
In contrast, in Romania cost weights were not adjusted in accordance with the clinical reality and this created the incentive to up-code in various medical specialties.
Most countries chose a combination of piloting paths, but the most frequent one was the first option mentioned here — a limited number of hospitals. The last option — a hospital-specific base rate that was gradually converted to a nationwide rate — was not followed by any country.
Capacity needed to start the DRG system If specific information technology requirements and a data generation system for case payments are already in place before a DRG-based system is introduced, as was the case in The former Yugoslav Republic of Macedonia, the shift to DRGs will be much easier.
This difficulty is inherent in that the availability of data on diagnosis is a prerequisite for DRG-based payments, but the systems needed to generate the necessary data are not usually set up until a DRG-based system is already in place.
For example, in an Estonian Health Insurance Fund publication it was noted that providers were only motivated to apply the coding scheme once DRGs were in place as a payment system. In the Viet Nam pilot, for example, the relevant input data were recorded at the hospital level but scattered among different work stations within the hospitals and were thus not fully ready to be used in a DRG-based payment system.
Incorrect coding practices can be overcome with training, but fraudulent coding practices also occur and call for regular coding practice audits. Thus, piloting should also be viewed as a way to eventually develop the necessary capacity.
Integration of private sector providers In many countries, DRG-based payments apply to both public and private sector providers. In fact, the shift from budget allocations to DRG-based payment systems makes the inclusion of the private sector in the provision of services — i.
Yet, when a purchaser offers different reimbursement for private sector services, the implications are many. For one thing, the expected efficiency gains of a DRG-based payment system are then limited to the public sector. In addition, there is no fair competition between public and private providers.
For example, in Romania, 40 DRG-based payments apply only to public providers, whereas private providers are paid on a negotiated fee for services.
When calculating DRG tariffs for private providers, the fact that these do not receive supply-side financing from the government should be borne in mind.To analyze, in terms of the length of stay (LOS), the use of resources by patients classified under surgical diagnosis-related groups (DRGs) with complication and/or comorbidity (DRGCCs), divided into subgroups where complications were and were not detected, and to explore the repercussions on hospital reimbursement.
Diagnosis Related Groups (DRGs): A classification system that groups patients according to principal diagnosis, presence of a surgical procedure, age, presence or absence of significant comorbidities or complications, and other relevant criteria.
DRG inflation: An increase over time in the number of separately identified case-mix classification groups.
PRINCIPAL FINDINGS: The total number of ordinary hospital admissions decreased from , to , between and , a population-based decrease of percent (p.
|Bulletin of the World Health Organization||The motivation for switching from the old cost-plus system, in which hospitals were reimbursed based on actual expenditures, to the PPS was to provide hospitals with better incentives to contain costs and increase efficiency. Yet the PPS may also provide incentives for hospitals to behave in undesirable ways.|
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diagnosis-related groups (DRGs), and many other LOS in U.S. hospitals has steadily declined since the payors soon followed suit.
1 Length of stay (LOS) per introduction of prospective payment.‘,*. Inpatient Hospital Services. Washington Apple Health (Medicaid) Inpatient Hospital Services.
Billing Guide. October 1, Every effort has been made to ensure this guide’s accuracy. If an actual or apparent conflict between this document and an agency rule arises, the agency rules apply.
Length Of Stay: What is the difference between “Average” and “Geometric Mean”? One focus of every hospital case management department or utilization management team is patient length of stay (LOS).
Whether measured in hours for observation or days for inpatients, shorter is generally better.