Πραγματικό κόστος έναντι κόστους βάσει ΚΕΝ ως μέθοδος αποζημίωσης των νοσοκομείων : εμπειρική ανάλυση των νοσηλευθέντων περιστατικών ενός ιδιωτικού νοσοκομείου
Actual cost versus DRG-based cost for hospital reimbursement : an empirical analysis of hospital episodes in a private hospital
KeywordsΠροοπτικός μηχανισμός αποζημίωσης ; Μίγμα περιπτώσεων ; ΚΕΝ ; Αποζημιώσεις ; Νοσοκομεία ; Diagnosis - Related Groups (DRGs) ; Prospective payment system ; Case mix
The introduction of DRGs as a prospective mechanism for hospital reimbursement was implemented as a strategy to enhance hospital efficiency, improve quality of care and contain hospital costs. Furthermore, DRG-based reimbursement seems to provide hospitals with an incentive to use their resources in an efficient manner. The aim of this thesis is to compare actual and DRG-based costs for hospital reimbursement using data from a private hospital for all episodes over the period 2012-2015. Actual costs of hospital episodes were computed using a micro-costing approach, whereby all resources used by each patient during their hospital stay were attached unit costs as set by the Ministry of Health by type of resource. Types of resources included length of stay in specialty, diagnostic tests and procedures, medications and surgical procedures. Using the recorded ICD-10 for each episode, a DRG code was then assigned to each episode to allow comparison of the estimated actual cost with the respective DRG-based cost as set by the Ministry of Health. The results of the analysis show that there are differences in the hospital costs estimated by the two methods. For some DRGs the estimated actual cost exceeded the DRGbased cost and vice versa. Similar findings apply to the actual length of stay and the DRGbased length of stay. Moreover, in some cases it was observed that although the actual cost was higher than the DRG-based cost, the actual length of stay was lower than the DRG-based length of stay. These differences are deemed important enough to question the effectiveness of the current DRG-based mechanism. It appears that DRGs need to be reassessed. It is of high importance that such micro-costing procedures be carried out in a large sample of hospitals, so that under- or over-estimates of the actual hospital cost relating to specific DRGs are identified and accurately measured. This will enable the DRG-based costs to be revised so that they are representative of the actual cost of hospital care.