Avaliação da produtividade de hospitais brasileiros pela metodologia do diagnosis related group (DRG) / Evaluation of the productivity of Brazilian hospitals by the methodology of diagnosis related group (DRG)

O gerenciamento de uma organização hospitalar exige provisionar seus custos/gastos com ferramentas que a aproximam da realidade. A tarefa de aferição da produtividade pode ser complexa e duvidosa, diversos métodos são experimentados e a utilização do DRG tem se mostrado eficiente, sendo utilizado na avaliação da produtividade através de desfechos assistenciais. Estudo transversal, avaliou 145.710 internações, no período de 2012-2014, utilizando a metodologia do DRG para medição de sua produtividade a partir da mediana do tempo de internação. Ao agruparmos todas as internações em clínicos (37,6%) e cirúrgicos (62,4%), várias análises puderam ser feitas de acordo com esse critério.O DRG como ferramenta para predição de dias de internação é uma alternativa eficiente, colaborando assim para o controle da produtividade que influencia diretamente nos gastos e custos dos produtos hospitalares e qualidade dos serviços.

The management requires a hospital organization to provision their costs/expenses with tools that approximate reality. The task of measuring productivity can be complex and uncertain, several methods are tested and the use of the DRG has been efficient, being used to assess the productivity through clinical outcomes. Cross-sectional study evaluated 145.710 hospitalizations in the period 2012-2014, using the DRG methodology for measuring productivity from the median length of hospitalization. When we group all hospitalizations in clinical (37.6%) and surgical (62.4%), multiple analyzes could be made according to this criterion. The DRG as a tool for prediction of hospital days is an effective alternative, thereby contributing tothe control of productivity that directly influences the costs of hospital expenses and product and service quality.

Impact of DRG Payment on the Length of Stay and the Number of Outpatient Visits After Discharge for Caesarean Section During 2004-2007 / 예방의학회지

OBJECTIVES: The purpose of this study was to examine the impact of Diagnosis-Related Group (DRG)-based payment on the length of stay and the number of outpatient visits after discharge in for patients who had undergone caesarean section. METHODS: This study used the health insurance data of the patients in health care facilities that were paid by the Fee-For-Service (FFS) in 2001-2004, but they participated in the DRG payment system in 2005-2007. In order to examine the net effects of DRG payment, the Difference-In-Differences (DID) method was adopted to observe the difference in health care utilization before and after the participation in the DRG payment system. The dependent variables of the regression model were the length of stay and number of outpatient visits after discharge, and the explanatory variables included the characteristics of the patients and the health care facilities. RESULTS: The length of stay in DRG-paid health care facilities was greater than that in the FFS-paid ones. Yet, DRG payment has no statistically significant effect on the number of outpatient visits after discharge. CONCLUSIONS: The results of this study that DRG payment was not effective in reducing the length of stay can be related to the nature of voluntary participation in the DRG system. Only those health care facilities that are already efficient in terms of the length of stay or that can benefit from the DRG payment may decide to participate in the program.

Participation Determinants in the DRG Payment System of Obstetrics and Gynecology Clinics in South Korea / 예방의학회지

OBJECTIVES: The Diagnosis Related Group (DRG) payment system, which has been implemented in Korea since 1997, is based on voluntary participation. Hence, the positive impact of this system depends on the participation of physicians. This study examined the factors determining participation of Korean obstetrics & gynecology (OBGYN) clinics in the DRG-based payment system. METHODS: The demographic information, practice-related variables of OBGYN clinics and participation information in the DRG-based payment system were acquired from the nationwide data from 2002 to 2007 produced by the National Health Insurance Corporation and the Health Insurance Review & Assessment Service. The subjects were 336 OBGYN clinics consisting of 43 DRG clinics that had maintained their participation in 2003-2007 and 293 no-DRG (fee-for-service) clinics that had never been a DRG clinic during the same period. Logistic regression analysis was carried out to determine the factors associated with the participation of OBGYN clinics in the DRG-based payment system. RESULTS: The factors affecting participation of OBGYN clinics in the DRG-based payment system were as follows (p<0.05): (1) a larger number of caesarian section (c/sec) claims, (2) higher cost of a c/sec, (3) less variation in the price of a c/sec, (4) fewer days of admission for a c/sec, and (5) younger pregnant women undergoing a c/sec. CONCLUSIONS: These results suggest that OBGYN clinics with an economic practice pattern under a fee-for-service system are more likely to participate in the DRG-based payment system. Therefore, to ensure adequate participation of physicians, a payment system with a stronger financial incentive might be more suitable in Korea.

Una metodología para evaluación de servicios de salud con deudausando ajuste de riesgos con morbilidad / A methodology to evaluate indebted health authorities using diagnosis-based risk adjustment

En este trabajo se desarrolla una metodología de evaluación de Servicios de Salud en búsqueda de explicaciones a la deuda. Pretende abrir ámbitos de explicación, a través del estudio de perfiles de riesgos de personas atendidas a nivel hospitalario en cada Servicio de Salud y la construcción de índices de eficiencia relativa. El trabajo tiene un carácter ilustrativo y pretende resaltar la metodología. De los ocho Servicios de Salud con deuda considerados, cinco presentan gastos esperados de sus pacientes superiores al promedio y son los únicos cinco, del grupo de 17 Servicios de Salud considerados, en esta situación. Esto implica que, en general, los Servicios de salud con deuda muestran gastos esperados superiores que los Servicios de Salud sin deuda. A su vez, 5 Servicios de Salud con deuda justifican sus gastos observados y se desempeñan de manera relativamente eficiente. Sin embargo, tres de ellos arrojan como resultados un indicador que muestra ineficiencia relativa. La metodología se muestra robusta a la hora de comparar Servicios de Salud, dado que permite homogeneizar su producción, al ajustar por riesgos de la población atendida a nivel hospitalario. No obstante, para ser más precisos ella puede ser mejorada en varios aspectos que se señalan.

The present study aims at developing a methodology to explain deficits in different Chilean Health Authorities in Chile. It intends to make comparable the Health Authorities by studying the diverse risk and hence casemix of the different Health Authorities, this resulting in different degrees of efficiency. The present study case is used illustratively being the centre of the research the proposed methodology. The results show that al least 5 of the more indebted HA are those with highest observed expenditures and functioning with relatively good degrees of efficiency in comparison to the rest of them. Despite the concrete results of the illustrative exercise, it is the robustness of the method to compare different Health Authorities the main result of the study. This robustness lies on the possibility of comparing Health Authorities and their populations, adjusting them by their risks and casemix.