Diagnosis Related Groups in Ukraine

Transcription

1 Diagnosis Related Groups in Ukraine Tihomir Strizrep, MD

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3 Ukraine: current situation The number of hospital beds: 8.7 per 1,000 population - the fourth largest in the world. Average length of stay (ALOS): the highest in the region after Russian Federation. Available information on treated cases for include data for some 0,4 million cases from 58 hospitals in 5 regions (out of 27 regions and about 2,5 thousand hospitals).

4 Hospital payment systems Advantages and disadvantages of different forms of hospital payment Payment system Transparency Fee-forservice DRGbased payment Global budget Number of services per case Activity Number of cases Expenditur e Control Technical Efficiency Quality Administrative simplicity

5 ...the single most influential postwar innovation in medical financing: prospective payment system (PPS) with diagnosisrelated groups (DRGs). Rick Mayes

6 During the last decades major reforms of health care systems have been implemented or are still ongoing in almost all European countries. Concerning the inpatient sector, these reforms were in most cases combined with the introduction of diagnosisrelated group (DRG) systems and corresponding patient classification systems (PCS).

7 DRG Diagnosis Related Group (DRG) based systems are a type of prospective funding that fixes prices in advance but typically does not fix quantities. DRGbased reimbursement systems were introduced to control healthcare expenditure, increase activity levels and standardize care.

8 Why DRGs? DRGs are often seen primarily as a way to pay hospitals for their services. However, they are used for a much wider range of objectives which can be grouped into three categories: increasing transparency supporting efficiency provision of hospital activity data.

9 Change to DRG System The idea is that if we know what hospitals produce we can then: measure their performance and compare it to their peers; pay for their output, rather than input; improve system efficiency and effectiveness;

10 Hospital expenditures in Croatia Year Total expenditure

11 Results Croatia

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13 Existing versions of the DRG system - NorDRG (Denmark, Finland, Iceland, Norway, Sweden, Estonia) - IDRG, APDRG, APRDRG (3M) - AR-DRG (Australia) - DPC (Japan) - CMG (Canada) - HCFA/CMS (USA) - HBCs (Hungary) - DBC (Netherlands) - HRG (GB) - GHM (France) PCS/E - LDF (Austria)

14 Models of health insurance in Europe and DRG = DRG

15 Why are More and More Countries Moving to DRG or Case-Mix Based Financing Systems? Cannot afford not to know what is being purchased Want increased transparency Want to distribute limited resources objectively and equitably Want to create incentives for providers to deliver care more efficiently, while maintaining or improving quality and access

16 Components Required for Developing a DRG-Based Financing System 1. Defining the cases treated by hospitals Coding and data collection Grouping cases into DRGs Analysis 2. Creating prices based on the costs of cases treated by hospitals in order to create the basis for a financing system Costing and data collection (cost data are needed at the hospital and patient level) Development of a base/reference price and DRG price list Analysis

17 ACTION PLAN on Implementation of the Diagnosis Related Groups System in Ukraine Item No. Main Areas Implementations Phases Deadlines 1. Forming Legal Fundamentals for implementation of the Diagnosis related groups (DRG) system in Ukraine 1.1. Legal acts, the regulatory and methodological framework for finding out possibilities and barriers to implementation of the DRG system in Ukraine should be analyzed; an expert opinion and recommendations on amendments to the legislation should be drawn up Based on the expert opinion and recommendations, new regulations should be developed or existing ones should be amended. September - October 2013 November January Classifiers of medical procedures and surgical October 2013 interventions, health care facility units, medical - January equipment and others should be developed or 2014 approved, as required for implementation of the DRG system Forms of primary records should be October - worked out and amended for implementations November of the DRG system in Ukraine, with due regard 2013 to the World Bank s recommendations.

18 ACTION PLAN on Implementation of the Diagnosis Related Groups System in Ukraine Item No. Main Areas Implementations Phases Deadlines 2. Selecting a DRG system for implementation in Ukraine 2.1. Organizations that maintain international DRG September - systems should be approached as to possibility, October 2013 terms and conditions of testing and further use of respective systems by Ukraine as a reference one Information provided by organizations that October - maintain international DRG systems should be December examined; permits for testing respective systems 2013 in the pilot health care facilities (HCF) should be processed and approved International DRG systems should be tested in the pilot HCF Subsequent to the testing held, technical requirements to the DRG system should be developed as per the needs of the Ukrainian health care system Procurement procedures for a DRG system license, DRG software, software and hardware systems and communication means for the Ukrainian DRG Implementation Center should be carried out. January - May 2014 June July - September

19 ACTION PLAN on Implementation of the Diagnosis Related Groups System in Ukraine Item No. Main Areas Implementations Phases Deadlines 3. Establishing 3.1. The Ukrainian DRG Implementation Center September - institutional fundamentals for should be set up. December 2013 implementation of the 3.2. The Steering Council on DRG under the MoH December national project on of Ukraine should be established and the 2013 development of the DRG system, its technical support, and regulation therefore should be approved Regional DRG implementation centers under September - the MoH of the AR of Crimea and health care December further development of departments at oblast, Kyiv and Sevastopol city 2013 the Ukrainian DRG state administrations should be set up. system 3.4. DRG implementation coordinators should be October 2013 appointed at the level of an oblast, cities of Kyiv and Sevastopol, pilot health care facilities for the purpose of coordinating the DRG coding and application process A list of the pilot health care facilities should December be defined and approved with the order of the MoH 2013 of Ukraine for the purpose of testing the international DRG systems provided.

20 ACTION PLAN on Implementation of the Diagnosis Related Groups System in Ukraine No. Main Areas Implementations Phases Deadlines 4 Forming skills and abilities of the staff which will be implementing the DRG system in Ukraine 5. Pilot project on implementation of the DRG system 4.1. A program of trainings, educational materials and December guidelines on DRG implementation in Ukraine should be 2013 developed; consultants to deliver training should be selected The DRG implementation coordinators should trained in coding and applying DRG at the level of an oblast, cities of Kyiv and Sevastopol, pilot health care facilities Regulatory, analytical and operational documents on the DRG system selected should be translated into Ukrainian, adapted and approved The DRG system should be introduced in the pilot health care facilities The pilot health care facilities should be provided with computer equipment and access to the web. January - May 2014 September - October 2014 October - December 2014 January - May Results of the DRG system introduction in the pilot health December care facilities should be analyzed, recommendations should be prepared as to rolling it out all over Ukrainian health care January 2015 facilities that provide secondary (specialized) and tertiary (highly specialized) care Based on the piloting results, the DRG software should be further worked out (if needed). December January 2015

21 ACTION PLAN on Implementation of the Diagnosis Related Groups System in Ukraine No. Main Areas Implementations Phases Deadlines 6. Implementation and technical support of the Ukrainian DRG system 6.1. The DRG system should be introduced in all Ukrainian health care facilities that provide secondary (specialized) and tertiary (highly specialized) care.

22 Thank you!