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
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Keywords
Προοπτικός μηχανισμός αποζημίωσης ; Μίγμα περιπτώσεων ; ΚΕΝ ; Αποζημιώσεις ; Νοσοκομεία ; Diagnosis - Related Groups (DRGs) ; Prospective payment system ; Case mixAbstract
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.