Original scientific paper
https://doi.org/10.3325/cmj.2021.62.561
The effects of diagnosis-related groups payment on efficiency of the hospital health care in Croatia
Karolina Kalanj
orcid.org/0000-0002-3105-9668
; Department of Medical Oncology, Clinic of Oncology, Clinical Hospital Center Zagreb, Zagreb, Croatia
Rick Marshall
; Epidemiologist and independent consultant in health system funding models, Eaglehawk Neck, Tasmania, Australia
Karl Karol
; Independant consultant, Melbourne, Victoria, Australia
Stjepan Orešković
; Univesity of Zagreb School of Medicine, Andrija Stampar School of Public Health, Zagreb, Croatia
Abstract
Aim To assess the impact of Croatian reforms related to
the funding of inpatient care on the efficiency of acute
hospitals.
Methods Between 2009 and 2018, the study analyzed
resourcing, performance, and financing data for 33 acute
hospitals. It used data from the Croatian Health Insurance
Fund (CHIF) and the Croatian Institute of Public Health and
included hospital activity and diagnosis-related grouping;
average length of stay (ALOS); hospital staffing; CHIF revenue streams; and hospital incomes and expenditures.
Results During the study period, the cost-efficiency of
Croatian public hospitals did not meaningfully improve.
While ALOS decreased by 14% and the number of beds
decreased by 12%, bed occupancy rates decreased by 9%,
acute inpatient admissions by 5%, and diagnosis-related
group (DRG)-weighted output by 16%. Hospitals operated at higher costs, as the average cost per DRG-weighted
case increased by 17%, from HRK 11 828 in 2016, to HRK
13 897 in 2018.
Conclusions In this period, Croatian reforms failed to improve hospital efficiency. This may be explained by the
failure of reformers to heed the experience of other countries, which showed that hospital payment reform of this
nature calls for systematic and coordinated actions, interagency collaboration, and a strategic approach where the
various interventions are in congruence and act to reinforce one another
Keywords
Hrčak ID:
278866
URI
Publication date:
23.12.2021.
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