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DRG Diagnosis Related Groups Diagnosis Related Groups in in Ukraine Ukraine Tihomir Strizrep, MD Tihomir Strizrep, MD 19.12.2013 19.12.2013
Transcript of Diagnosis Related Groups in Ukraine - ciet.kiev.ua · Diagnosis related groups (DRG) system in...
DRG
Diagnosis Related Groups Diagnosis Related Groups inin
Ukraine Ukraine
Tihomir Strizrep, MDTihomir Strizrep, MD
19.12.201319.12.2013
DRG
DRG Ukraine: current situation
• The number of hospital beds:– 8.7 per 1,000 population - the fourth
largest in the world.• Average length of stay (ALOS):
- 12.7 - the highest in the region after Russian Federation.
• Available information on treated cases for 2012-2013. include data for some 0,4 million cases from 58 hospitals in 5 regions (out of 27 regions and about 2,5 thousand hospitals).
DRG
Paymentsystem
ActivityExpenditur
e Control
TechnicalEfficiency
QualityAdmini-strative
simplicity
Trans-parency
Number of services per case
Number of cases
Fee-for-service + + - 0 0 - 0
DRG-based payment
- + 0 + 0 - +
Global budget - - + 0 0 + -
Hospital payment systems
Advantages and disadvantages of different forms of hospital payment
DRG
• „...the single most influential postwar innovation in medical financing: prospective payment system (PPS) with diagnosis-related groups (DRGs).”
Rick Mayes
DRG
• During the last decades major reforms of health care systems have been implemented or are still ongoing in almost all European countries. Concerning the inpatient sector, these reforms were in most cases combined with the introduction of diagnosis-related group (DRG) systems and corresponding patient classification systems (PCS).
DRG DRG
• Diagnosis Related Group (DRG) based systems are a type of prospective funding that fixes prices in advance but typically does not fix quantities. DRG-based reimbursement systems were introduced to control healthcare expenditure, increase activity levels and standardize care.
DRG
• DRGs are often seen primarily as a way to pay hospitals for their services. However, they are used for a much wider range of objectives which can be grouped into three categories: – increasing transparency– supporting efficiency – provision of hospital activity data.
Why DRGs?
DRG
The idea is that if we know what hospitals produce we can then:
• measure their performance and compare it to their peers;
• pay for their output, rather than input;
• improve system efficiency and effectiveness;
Change to DRG System
DRG
Year Total expenditure2009 1.520.507.836
2010 1.470.611.623
2011 1.455.341.783
2012 1.413.059.578
Hospital expenditures in Croatia
DRG ResultsCroatia 2002 – 2012.
DRG
DRG Existing versions of the DRG system
PCS/E
- NorDRG (Denmark, Finland, Iceland, Norway, Sweden, Estonia)
- IDRG, APDRG, APRDRG (3M)- AR-DRG (Australia)- DPC (Japan)- CMG (Canada)- HCFA/CMS (USA) - HBCs (Hungary) - DBC (Netherlands)- HRG (GB)- GHM (France) - LDF (Austria)
DRG
= DRG
Models of health insurance in Europe and DRG
DRG Why are More and More Countries Moving to DRG or Case-Mix Based Financing Systems?
• Cannot afford not to know what is being purchased
• Want increased transparency
• Want to distribute limited resources objectively and equitably
• Want to create incentives for providers to deliver care more efficiently, while maintaining or improving quality and access
DRG Components Required for Developing a DRG-Based Financing System
1. Defining the cases treated by hospitals– Coding and data collection– Grouping cases into DRGs– Analysis
2. Creating prices based on the costs of cases treated by hospitals in order to create the basis for a financing system
– Costing and data collection (cost data are needed at the hospital and patient level)
– Development of a base/reference price and DRG price list
– Analysis
DRGACTION PLAN
on Implementation of the Diagnosis Related Groups System in Ukraine
Item No.
Main Areas Implementations Phases Deadlines
1. Forming Legal Fundamentals for implementation of the Diagnosis related groups (DRG) system in Ukraine
1.1. Legal acts, the regulatory and methodological framework for finding out possibilities and barriers to implementation of the DRG system in Ukraine should be analyzed; an expert opinion and recommendations on amendments to the legislation should be drawn up.
September -October 2013
1.2. Based on the expert opinion and recommendations, new regulations should be developed or existing ones should be amended.
November 2013 -January 2014
1.3. Classifiers of medical procedures and surgical interventions, health care facility units, medical equipment and others should be developed or approved, as required for implementation of the DRG system.
October 2013 - January 2014
1.4. Forms of primary records should be worked out and amended for implementations of the DRG system in Ukraine, with due regard to the World Bank’s recommendations.
October -November 2013
DRGACTION PLAN
on Implementation of the Diagnosis Related Groups System in Ukraine
Item No.
Main Areas Implementations Phases Deadlines
2. Selecting a DRG system for implementation in Ukraine
2.1. Organizations that maintain international DRG systems should be approached as to possibility, terms and conditions of testing and further use of respective systems by Ukraine as a reference one.
September -October 2013
2.2. Information provided by organizations that maintain international DRG systems should be examined; permits for testing respective systems in the pilot health care facilities (HCF) should be processed and approved.
October -December 2013
2.3. International DRG systems should be tested in the pilot HCF.
January -May 2014
2.4. Subsequent to the testing held, technical requirements to the DRG system should be developed as per the needs of the Ukrainian health care system.
June
2.5. Procurement procedures for a DRG system license, DRG software, software and hardware systems and communication means for the Ukrainian DRG Implementation Center should be carried out.
July -September
DRGACTION PLAN
on Implementation of the Diagnosis Related Groups System in Ukraine
Item No.
Main Areas Implementations Phases Deadlines
3. Establishing institutional fundamentals for implementation of the national project on development of the DRG system, its technical support, and further development of the Ukrainian DRG system
3.1. The Ukrainian DRG Implementation Center should be set up.
September -December 2013
3.2. The Steering Council on DRG under the MoHof Ukraine should be established and the regulation therefore should be approved.
December 2013
3.3. Regional DRG implementation centers under the MoH of the AR of Crimea and health care departments at oblast, Kyiv and Sevastopol city state administrations should be set up.
September -December 2013
3.4. DRG implementation coordinators should be appointed at the level of an oblast, cities of Kyiv and Sevastopol, pilot health care facilities for the purpose of coordinating the DRG coding and application process.
October 2013
3.5. A list of the pilot health care facilities should be defined and approved with the order of the MoHof Ukraine for the purpose of testing the international DRG systems provided.
December 2013
DRGACTION PLAN
on Implementation of the Diagnosis Related Groups System in Ukraine
No. Main Areas Implementations Phases Deadlines4 Forming skills
and abilities of the staff which will be implementing the DRG system in Ukraine
4.1. A program of trainings, educational materials and guidelines on DRG implementation in Ukraine should be developed; consultants to deliver training should be selected.
December 2013
4.2. The DRG implementation coordinators should trained in coding and applying DRG at the level of an oblast, cities of Kyiv and Sevastopol, pilot health care facilities.
January -May 2014
5. Pilot project on implementation of the DRG system
5.1. Regulatory, analytical and operational documents on the DRG system selected should be translated into Ukrainian, adapted and approved.
September -October 2014
5.2. The DRG system should be introduced in the pilot health care facilities.
October -December 2014
5.3. The pilot health care facilities should be provided with computer equipment and access to the web.
January -May 2014
5.4. Results of the DRG system introduction in the pilot health care facilities should be analyzed, recommendations should be prepared as to rolling it out all over Ukrainian health care facilities that provide secondary (specialized) and tertiary (highly specialized) care.
December 2014 -January 2015
5.5. Based on the piloting results, the DRG software should be further worked out (if needed).
December 2014 -January 2015
DRGACTION PLAN
on Implementation of the Diagnosis Related Groups System in Ukraine
No. Main Areas Implementations Phases Deadlines6. Implementation
and technical support of the Ukrainian DRG system
6.1. The DRG system should be introduced in all Ukrainian health care facilities that provide secondary (specialized) and tertiary (highly specialized) care.
2015–2017
DRG
Thank you!
