Diagnosis Related Groups: Approval and suitability for the Greek National Health System

The Diagnosis-Related Groups (DRGs), is a method that identifies patients with similar resources use, based on statistical evaluation of hospital records. Statistics provide the Diagnosis related consumed resources and, thus, they enable the calculation of an average patient’s case-cost. On the basis of the Hospital activity levels and case mix, the health authorities can allocate the annual hospital budgets, both, prospectively and retrospectively. The purpose of the present study is to determine whether the implementation of the DRGs as a refunding methodology is, both, welcomed and feasible in the Greek National Health System (NHS). The aim was to collect information on the attitude, the knowledge, the experience, and the acceptability of the DRGs, as well as, on the existence of the necessary infrastructure. Two methods were used: First, a questionnaire was designed and sent to the Departments of Administrative and Economic Affairs of 50 Hospitals, corresponding to the 38% of NHSHospitals, and to all of the 17 Regional Health Authorities. Second, a semi structured interview was designed for health professionals of the NHS, originating from different disciplines. The collected evidence revealed a relative low percentage of, first, familiarity with the DRGs, i.e. 45% for the questionnaire and 62.5% for the interviews, second, correlation between postgraduate education and familiarity (corr. = -0.66), third, familiarity and acceptability of the DRGs, and fourth, acceptability and suitability for the Greek NHS (corr. = -0.85). The Information Technologies (IT) infrastructure was found to be minimal in the Greek hospitals. The DRGs were ranked as the best method for approaching and refunding Hospital-care cost. The appropriateness of the DRGs approach in the Greek NHS, was criticized on the grounds of personnel resistance, lack of experience, ethical dilemmas, lack of political will to implement the DRGs, high initial investment cost, in both, NHS and health-insurance funds, lack of infrastructure, and finally, the existence of higher priorities for the Greek NHS. The study concluded that the implementation of DRGs in the NHS is a task to be considered, but before introducing it, the government should launch IT and Electronic Patient Record in the Hospitals. On the other hand, the Health-insurance organizations should train their personnel, on both, IT and the DRGs methodology, in order to, first, adapt the DRGs to the Greek settings, second, calculate cost weights and pre test the DRGs in some hospitals, to gain experience, and third, make decisions concerning the real cost of health care. All the above factors contribute to a long term plan for the employment of the DRGs in the Greek NHS.