Reforming reimbursement of public hospitals in Greece during the economic crisis: Implementation of a DRG system

Polyzos, Nikolaos; Karanikas, Haralampos; Thireos, Eleftherios; Kastanioti, Catherine; Kontodimopoulos, Nick

doi:10.1016/j.healthpol.2012.09.011

Cited by 69 publications

(71 citation statements)

References 23 publications

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“…In addition, a DRG system was regarded as an important vehicle for transforming inpatient care towards a more market-driven system and as a more equitable mechanism for public resource allocation across the country to address geographical disparities. This paper adds to the growing literature in the field examining the practicalities of implementing DRGs and how the challenges can be approached or mitigated 5,6 .…”

Section: Introductionmentioning

confidence: 99%

Introducing Diagnosis-Related Groups in Kazakhstan: Evolution, achievements, and challenges

Chanturidze

Esau

Hölzer³

et al. 2016

Health Policy

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In 2012, Kazakhstan introduced Diagnosis-Related Groups (DRGs), as part of a package of reforms which sought to contain costs and to improve efficiency and transparency in the health system; but the main challenge was to design and implement a DRG system in just one year.In 2011-2012, Kazakhstan developed its own DRG system. Initially 180 DRGs were defined to group inpatient cases but this number was subsequently expanded to more than 400. Because of time limits, the cost weights had to be derived in the absence of existing standard hospital cost accounting systems, and a national patient data transfer system also needed developing. Most importantly, huge efforts were needed to develop a regulatory framework and build up DRG capabilities at a national level.The implementation of DRGs was facilitated by strong political will for their introduction as part of a coherent package of health reforms, and consolidated efforts to build capacity. DRGs are now the key payment mechanism for hospitals. However the reforms are not fully institutionalized: the DRG structure is continuously being refined in a context of data limitations, and the revision of cost weights is most affected by insufficient data and the lack of standardized reporting mechanisms.Capacity around DRG coding is also still being developed.Countries planning to introduce DRG systems should be aware of the challenges in moving too quickly to implement DRGs as the main hospital reimbursement mechanism.

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Section: Introductionmentioning

confidence: 99%

Introducing Diagnosis-Related Groups in Kazakhstan: Evolution, achievements, and challenges

Chanturidze

Esau

Hölzer³

et al. 2016

Health Policy

View full text Add to dashboard Cite

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“…But from the available data in 2011, it is evident that Ireland (Connolly and Hyndman, 2011), France, Germany, Romania, Sweden, Portugal, Spain, Greece, Italy and Cyprus have also made considerable efforts to introduce the accrual accounting basis at the national level (FEE, 2011). It is also necessary to mention Australia and Canada, which are considered to be the most developed countries in the usage of the accrual accounting basis not only for financial reporting but also for budgeting purposes at all levels of government (Mehrolhassani and Emami, 2013 have introduced the DRG methodology at the sectoral level for paying public health services provided by public hospitals (Polyzos et al, 2013;Christensen, Laegreid and Stigen, 2004;Pettersen, 2001;Helmig and Lapsley, 2001;SanchezMartinez et al, 2006). But in some countries like Ireland, Germany, France, Finland and UK, it was also introduced at the institutional level (O'Reilly et al, 2012).…”

Section: Ivana Dražić Lutilsky Berislav žMuk and Martina Dragijamentioning

confidence: 99%

Cost Accounting as a Possible Solution for Financial Sustainability of Croatian Public Hospitals

Lutilsky

Žmuk

Dragija

2016

CES

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The purpose of this paper is to present the current usage of cost accounting methodology in Croatian public hospitals through conducted empirical research and to provide opinions of accountants and financial officers regarding possible implementation of cost accounting methodology in public hospitals.In the paper, the authors analyze the accounting system in Croatian public hospitals, identifying the flaws of the current accounting system with regard to the recording and allocation of costs. National healthcare systems of different European countries provide a theoretical background for the usage of accrual accounting basis and cost accounting methodologies, showing better governance and financial sustainability of public hospitals which have introduced cost accounting methodology. The conducted empirical research shows that accountants and financial officers believe that the healthcare system in Croatia is ready for a change in the current accounting system based on the modified accrual Croatian Economic Survey : Vol. 18 : No. 2 : December 2016 : pp. 5-38 basis through the implementation of accrual accounting basis and full costing approach to cost allocation. Full costing approach is also known as activity-based accounting method for cost allocation. The authors also recommend some initial steps for implementation of the new cost accounting system in Croatian public hospitals. Ivana Dražić Lutilsky

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“…Moreover, the DRG-prospective reimbursement system was introduced, and an operational redeployment of 131 Greek public hospitals was partially made. [8] There is a twofold purpose for this study: first is to examine the efficiency of 112 Greek public hospitals in 2009 by evaluating the importance of bootstrapping techniques and investigating the effects of contextual factors on hospital efficiency. Second, is to examine the magnitude of the effect that a quality output variable (mortality rate adjusted by the number of surgeries) imposes on the efficiency estimation.…”

Section: Introductionmentioning

confidence: 99%

Two-stage hospital efficiency analysis including qualitative evidence: A Greek case

Nektarios

Constantopoulos

et al. 2016

JHA

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Background: The European Union health policy agenda stresses the importance of environmental and qualitative factors in structural hospital reforms. In response to the economic crisis, both cost containment and performance improvements of the Greek hospital sector, have become a pertinent issue for overall reforms. Objective: The study examines the efficiency of 112 Greek public hospitals, by applying bootstrapping techniques and investigating the effect of contextual factors on hospital efficiency. Furthermore, the effect of qualitative evidence, on hospital efficiency is explored by focusing on a subset of 28 large hospitals. Methods: The quality aspects of the Greek hospitals are investigated by applying two models of Data Envelopment Analysis (DEA), augmented by bootstrapping techniques, in order to assess the importance of quality dimensions on the efficiency of hospital scores. In addition, two Tobit regression models are estimated assessing the contribution of contextual factors, in the efficiency and bias-corrected efficiency scores. Results: Efficiency analysis indicated that only 23.2% of the hospitals are fully efficient (0.96-1.00), 37.5% are efficient (0.71-0.95) while 39.3% are inefficient (0.30-0.70). The Kolmogorov-Smirnov test, between the original and the bootstrapcorrected efficiency, indicates that their distributions are significantly different (p-value < .001). The environmental factors, influencing efficiency, are Occupancy Rate and the ratio between Outpatient Visits and Inpatient Days. Results indicate that the inclusion of Risk-Adjustment Mortality Rate significantly influences (p-value < .05) the efficiency of the hospitals. Conclusions: In the era of economic crisis, the inclusion of quality variables and the use of bootstrapping techniques provide a vital framework in assessing the efficiency of the hospital sector.

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Reforming reimbursement of public hospitals in Greece during the economic crisis: Implementation of a DRG system

Cited by 69 publications

References 23 publications

Introducing Diagnosis-Related Groups in Kazakhstan: Evolution, achievements, and challenges

Introducing Diagnosis-Related Groups in Kazakhstan: Evolution, achievements, and challenges

Cost Accounting as a Possible Solution for Financial Sustainability of Croatian Public Hospitals

Two-stage hospital efficiency analysis including qualitative evidence: A Greek case

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