Izvorni znanstveni članak
Changing Patient Classification System for Hospital Reimbursement in Romania
Ciprian-Paul Radu
; National School of Public Health and Health Services Management Bucharest, Romania
Delia Nona Chiriac
; National School of Public Health and Health Services Management Bucharest, Romania
Cristian Vladescu
; National School of Public Health and Health Services Management Bucharest, Romania
Sažetak
Aim To evaluate the effects of the change in the diagnosisrelated
group (DRG) system on patient morbidity and hospital
financial performance in the Romanian public health
care system.
Methods Three variables were assessed before and after
the classification switch in July 2007: clinical outcomes, the
case mix index, and hospital budgets, using the database
of the National School of Public Health and Health Services
Management, which contains data regularly received from
hospitals reimbursed through the Romanian DRG scheme
(291 in 2009).
Results The lack of a Romanian system for the calculation
of cost-weights imposed the necessity to use an imported
system, which was criticized by some clinicians for
not accurately reflecting resource consumption in Romanian
hospitals. The new DRG classification system allowed
a more accurate clinical classification. However, it also exposed
a lack of physicians’ knowledge on diagnosing and
coding procedures, which led to incorrect coding. Consequently,
the reported hospital morbidity changed after the
DRG switch, reflecting an increase in the national case-mix
index of 25% in 2009 (compared with 2007). Since hospitals
received the same reimbursement over the first two
years after the classification switch, the new DRG system
led them sometimes to change patients’ diagnoses in order
to receive more funding.
Conclusion Lack of oversight of hospital coding and reporting
to the national reimbursement scheme allowed
the increase in the case-mix index. The complexity of the
new classification system requires more resources (human
and financial), better monitoring and evaluation, and improved
legislation in order to achieve better hospital resource
allocation and more efficient patient care
Ključne riječi
DRG scheme; public health; Romanian public
Hrčak ID:
58470
URI
Datum izdavanja:
15.6.2010.
Posjeta: 1.203 *