Physician perspectives on the implications of the diagnosis‐related groups for medical practice in Turkey: A qualitative study

Abstract

Hospital reimbursement models might have unintended consequences for medical practice. In Turkey, a mixed reimbursement scheme, based on the diagnosis-related group (DRG) model and global budget, was gradually introduced as part of the country's 2003 healthcare reforms. This article examines the impacts of the DRG model on medical practice in Turkey, as perceived by physicians working in public and private hospitals. This study draws on an analysis of 14 interviews with physicians. The findings reveal that the implementation of the DRG has transformed medical practice into a process of cost-benefit optimisation which involves balancing the income and expenses of hospitals against patients' medical needs. To mitigate the negative effects of the DRG, the current model may need to be reformed, particularly to grant exemptions from the standard reimbursement structure for patients who are experiencing complications and/or multiple health conditions.

Barriers and Facilitators to Health-Care Provider Payment Reform – A Scoping Literature Review

“… [ 41 , 43 , 48 , 49 , 55 , 57 , 61 , 65 , 70 , 79 ] Provider reluctance or opposition to reform initiatives seeming to compromise their professional/ clinical autonomy or ethics. [ 31 , 33 , 37 , 39 , 52 , 53 , 55 , 57 , 69 , 80 ] Distrust due to previously failed reform attempts or between stakeholders (eg, care providers and government). [ 33 , 41 , 43 , 47 , 48 , 62 ] Reluctance due to difficulty/the inertia of providers to adjust to the new structure in healthcare.…”

“… [ 55 , 63 , 79 ] Other design (technical) challenges: defining a bundle, determining accountability, tariffs, evaluation criteria, outliers, gaming, etc. [ 14 , 31–33 , 40 , 51 , 53 , 55 , 56 , 58 , 59 , 67–70 , 74 , 75 ] Hurdles in implementation structure of the payment system Confusion due to conflicting/ administrative incongruence between major actors. [ 14 , 33 , 41 , 45 , 47 , 55 , 75 , 76 ] Fragmented implementation structure of the payment system.…”

“… [ 45 , 68 ] Instability for hospital budgets following reform (eg, due to lack of hospital autonomy in spending). [ 32 , 34 , 53 ] Having multiple initiatives under way deduce the resources and dilute the effort of any given reform. [ 14 ] Challenges related to the market structure Market environments unable to incorporate diverse public and private stakeholders (eg, public and private markets operating under different IT/reporting systems).…”

“… [ 14 , 32 , 35 , 41 , 43 , 45 , 46 , 51 , 55 , 59 , 61 , 62 , 64 , 66 , 70 , 71 , 73 , 78 ] Support by larger shareholders [ 14 , 33 , 38 , 48 , 51 , 53 , 63 , 64 , 73 , 76 , 78 , 80 ] Government interests to create a sense of urgency for a payment reform initiative. [ 14 , 31 , 41 , 45 , 48 , 51 , 53 , 60 , 63 , 80 ] High level of commitment by politics/political parties or policymakers’ rationales [ 14 , 31 , 33 , 38 , 41 , 45 , 51 , 63 , 64 , 76 ] …”

Impact of Medical–Pharmaceutical Separation Reform on Hospitalization Expenditure in Tertiary Public Hospitals: Difference-in-Difference Analysis Based on Panel Data from Beijing

“…Given the limited health insurance funds available, the reform of health insurance payment methods such as diagnosis-related-group payment (DRG) has become an important measure to address these challenges. 14 As the first region in China to successfully develop and systematically apply DRG, Beijing Municipality developed the Beijing version of the DRG payment program (BJ-DRG). The BJ-DRG was first applied in the diagnostic and therapeutic environment in Beijing in 2008 and officially implemented DRG payment in six hospitals in July 2011.…”