BACKGROUND This study aimed to evaluate the impact of diagnosis-related group (DRG) payments on health-care providers' behavior and the potential best course of action to make a profit under a DRG payment mechanism. METHODS This is a natural experiment study with a tertiary hospital-based dataset. Under a consecutive three-period (3 years) or 12-period (12 seasons) design, length of stay, med...

THE PROBLEMS OF DOCUMENTING MEDICAL RECORDS IN IMPLEMENTATION A PAYMENT SYSTEM BASED ON DIAGNOSIS-RELATED GROUPS (DRG): QUALITATIVE RESEARCH

In Germany, there are about 2100 hospitals providing care for about 17 million inpatient cases per year.3 Hospitals are financed through a system of ‘dual financing’, which means that they receive funds from two different sources: infrastructure investments are covered directly by tax-funded state budgets, whereas operating costs are paid mostly by sickness funds and private health insurers.4 T...

OBJECTIVE This paper provides a comprehensive overview of hospital payment systems based on diagnosis-related groups (DRGs) in low- and middle-income countries. It also explores design and implementation issues and the related challenges countries face. METHODS A literature research for papers on DRG-based payment systems in low- and middle-income countries was conducted in English, French an...

South Carolina Medicaid implemented prospective payment by diagnosis-related group (DRG) for inpatient care. The rate of complications among newborns and deliveries doubled immediately. The case-mix index for newborns increased 66.6 percent, which increased the total Medicaid hospital expenditure 5.5 percent. Outlier payments increased total expenditure further. DRG distribution change among ne...

Much concern has been expressed about the Medicare Prospective Payment System's impact on access to care. In this study, we examine the financial impact of diagnosis-related group (DRG) payment for chronic ventilator-dependent Medicare patients. During a one-year period, payment for 95 Medicare patients who received a minimum of three days of continuous ventilator treatment and who spent no tim...

Preface The increase in the cost of hospital care has been a persistent and growing problem for both the Medicare program and the general public for more than iS years. A substantial portion of the increase in hospital costs has been attributed to an increase in the use of new and existing medical technologies. Congress recently legislated a new prospective per-case payment system for the Medic...

background as part of the eurodrg project, researchers from eleven countries (i.e. austria, england, estonia, finland, france, germany, ireland, netherlands, poland, sweden, and spain) compared how their diagnosis-related groups (drg) systems deal with cholecystectomy patients. the study aims to assist surgeons and national authorities to optimize their drg systems.   methods national or region...

England, France, Germany, the Netherlands, and Sweden spend less as a share of gross domestic product on hospital care than the United States while delivering high-quality services. All five European countries have hospital payment systems based on diagnosis-related groups (DRGs) that classify patients of similar clinical characteristics and comparable costs. Inspired by Medicare's inpatient pr...

In 1988, an ambitious and extensive project was undertaken in New Jersey to evaluate severity class adjustment of the all-payer prospective payment system. Another project objective was to evaluate alternative strategies for refining diagnosis-related groups (DRGs). The evaluation presented here includes a comparison of DRG refinement using Computerized Severity Index classes and Yale Universit...