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      How to Make Diagnosis Related Groups Payment More Feasible in Developing Countries- A Case Study in Shanghai, China

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          Abstract

          Background

          Given limited health sources, how to make DRGs (Diagnosis Related Groups) more feasible is a big question in developing countries. This study contributes to the debate on how to bridge the pay-for-service and DRGs during the transitional period of payment reform.

          Methods

          From 2008 to 2012, 20740 patients with cirrhosis or duodenal ulcer disease were chosen as sample. Using multiple linear regression analysis, the interrelationships between the total medical expenses of the inpatients, and age, gender of the inpatients, length of stay (LOS), region and economic level of the hospitals were examined.

          Results

          The main findings were 1) length of stay (LOS) and the economic level of treatment location had a statistically significant impact on patients with cirrhosis or duodenal ulcer disease. Meanwhile gender is not a significant factor for both of them. 2) Under the premise of limited resources, developing countries should first narrow down to screen for common and frequently occurring diseases, then study the key factors which affect the treatment cost of the diseases.

          Conclusion

          Based on picking out common diseases and their key factors, Simplification of the DRGs setting process will greatly increase the efficiency of implementing DRGs in the developing world.

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          Unwanted incidents during transition of geriatric patients from hospital to home: a prospective observational study

          Marianne Mesteig, Jorunn Helbostad, Olav Sletvold … (2010)
          Background Geriatric patients recently discharged from hospital experience increased chance of unplanned readmissions and admission to nursing homes. Several studies have shown that medication-related discrepancies are common. Few studies report unwanted incidents by other factors than medications. In 2002 an ambulatory team (AT) was established within the Department of Geriatrics, St. Olavs University Hospital HF, Trondheim, Norway. The AT monitored the transition of the patients from hospital to home and four weeks after discharge in order to reveal unwanted incidents. The aim of the present study was to describe unwanted incidents registered by the AT among patients discharged from a geriatric evaluation and management unit (GEMU) by character, frequency and stage in the transitional process. Only unwanted incidents with a severity making contact with the primary health care (PHC) necessary were registered. Methods A prospective observational study with patients treated in the GEMU and followed by the AT was performed. Current practice included comprehensive geriatric assessment and management including discharge planning in the GEMU and collaboration with the primary health care on appointments on assistance to be provided after discharge from hospital. Unwanted incidents severe enough to induce contact with the primary health care were registered during the transitional phase and after discharge. Results 118 patients (65% female), with mean age 83.2 ± 6.4 years participated. Median Barthel Index at discharge was 18 (interquartile range 16-19) and median Mini Mental Status Examination 24 (interquartile range 21-26). A total of 146 unwanted incidents were registered in 70 (59%) of the patients. Most frequent were unwanted incidents related to drug prescription regime (32%), exchange of information in and between the GEMU and the primary health care (25%) and service or help provided from the PHC (17%). Conclusions Despite a seemingly well-organised system for transition of patients from the GEMU to their homes, one or more unwanted incidents occurred in most patients during discharge or four weeks post discharge. The study has revealed areas of importance for improving transitional care of geriatric patients.
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            Hospital case payment systems in Europe.

            Jonas Schreyögg, Anthony Smith, Reinhard Busse (2006)
            Since the introduction of the system of diagnosis related groups (DRGs) for USA Medicare patients in 1983, case payment mechanisms have gradually become the principal means of reimbursing hospitals in most developed countries. The use of case payments nevertheless poses severe technical and policy challenges, and there remain many unresolved issues in their implementation. This paper introduces a special issue of the journal that describes and compares experience with the use of case payments for reimbursing hospitals in nine European countries. The editorial sets the policy scene, and argues that DRG systems must be seen both as a technical reimbursement method and as a fundamental incentive mechanism within the health system.
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              A qualitative study of DRG coding practice in hospitals under the Thai Universal Coverage Scheme

              Krit Pongpirul, Damian G Walker, Peter Winch … (2011)
              Background In the Thai Universal Coverage health insurance scheme, hospital providers are paid for their inpatient care using Diagnosis Related Group-based retrospective payment, for which quality of the diagnosis and procedure codes is crucial. However, there has been limited understandings on which health care professions are involved and how the diagnosis and procedure coding is actually done within hospital settings. The objective of this study is to detail hospital coding structure and process, and to describe the roles of key hospital staff, and other related internal dynamics in Thai hospitals that affect quality of data submitted for inpatient care reimbursement. Methods Research involved qualitative semi-structured interview with 43 participants at 10 hospitals chosen to represent a range of hospital sizes (small/medium/large), location (urban/rural), and type (public/private). Results Hospital Coding Practice has structural and process components. While the structural component includes human resources, hospital committee, and information technology infrastructure, the process component comprises all activities from patient discharge to submission of the diagnosis and procedure codes. At least eight health care professional disciplines are involved in the coding process which comprises seven major steps, each of which involves different hospital staff: 1) Discharge Summarization, 2) Completeness Checking, 3) Diagnosis and Procedure Coding, 4) Code Checking, 5) Relative Weight Challenging, 6) Coding Report, and 7) Internal Audit. The hospital coding practice can be affected by at least five main factors: 1) Internal Dynamics, 2) Management Context, 3) Financial Dependency, 4) Resource and Capacity, and 5) External Factors. Conclusions Hospital coding practice comprises both structural and process components, involves many health care professional disciplines, and is greatly varied across hospitals as a result of five main factors.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Iran J Public Health
                Journal ID (iso-abbrev): Iran. J. Public Health
                Journal ID (publisher-id): IJPH
                Title: Iranian Journal of Public Health
                Publisher: Tehran University of Medical Sciences
                ISSN (Print): 2251-6085
                ISSN (Electronic): 2251-6093
                Publication date (Print): May 2014
                Volume: 43
                Issue: 5
                Pages: 572-578
                Affiliations
                [1]1. Shanghai Tenth People’s Hospital, Tongji University School of Medicine , China
                [2]2. School of Medicine, Tongji University , China
                [3]3. Zhou Pu Hospital, Shanghai , China
                [4]4. Fudan University , China
                Author notes
                * Corresponding Author: Tel: +92-21-5689860 Email: haomo001@ 123456sina.com
                Article
                Accession ID: IJPH-43-572
                PMC ID: 4449405
                PubMed ID: 26060758
                SO-VID: 7334ce35-1e30-4d2e-bd86-de703745b138
                Copyright © Copyright © Iranian Public Health Association & Tehran University of Medical Sciences
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

                History
                Date received : 10 December 2013
                Date accepted : 14 April 2014
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Public health
                Keywords: diagnosis related groups,payment,hospitals,china
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: diagnosis related groups, payment, hospitals, china

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