The Use of Diagnosis-Related Group-Based Reimbursement in the Czech Hospital Care System

Abstract

(1) Background: Diagnosis-Related Groups (DRG), one possibility of a hospital payment system, are currently used in most European countries. Introduced to the Czech system in the 1990s, the DRGs are currently used mainly for care reporting and partly for reimbursement. According to most experts, the use of DRG remain controversial. The goal of this paper was to study the effects of the current Czech DRG system on hospitals financing and, on this basis, to propose possible changes to the reimbursement mechanism in the Czech Republic. (2) Methods: Qualitative research methods were used for evaluating DRG mechanisms of application in three selected healthcare establishments in the CR in the period of 2012–2018. (3) Results: Our study shows that the current implementation of the DRG system is set up in a way that is very similar to traditional flat rates and is unlikely to yield major positive effects of the DRG mechanism, such as predictability of payments for hospitalisation cases, care quality and efficiency and transparent financing. (4) Conclusions: Based on our results, deep systemic change of the reimbursement mechanism in the Czech Republic is necessary. We propose five partial measures leading to the cultivation of the Czech DRG.

Treatment of moderate to severe respiratory COVID-19: a cost-utility analysis

“…DRG based systems are designed to provide a package price for a bundle of care based on acuity and increase efficiency of care 19 . These are used in much of Europe 20 and a number of Asian Pacific countries 19 . Impacts on the length of stay would affect physician fees which are approximately $100/day for the ward and $230/day for the ICU 21 which are all less expensive than one dose of remdesivir.…”

“…Given data suggesting remdesivir might shorten 5 or lengthen 22 hospitalization, the impact on length of stay requires further study. Although this model is most directly appliable to DRG using countries, DRG rates reflect the average cost for diagnoses in the group 20 and so are a reasonable estimate of cost; as such, the model outputs can reasonably be extrapolated to other countries that are based on a fee-for-service model.…”

Challenges of implementing diagnostic‐related groups and healthcare promotion in Iran: A strategic applied research

“…35,36 In this regard, technical and managerial capacity building at the national level is necessary to support the implementing DRGs. 31,37 In a study by Kotherova et al, 38 which aimed to investigate the effects of DRGs on the financing of Czech hospitals and make suggestions for possible changes in the country's hospital reimbursement mechanism, some of the essential DRGs-related challenges identified and classified in eight categories: The need for a consistent definition of group creation, the tendency to increase the seriousness of cases, the focus on quality, the base rate convergence, repeated hospitalization and length of stay, professional coding, cost billing system, level of centralization. Also, in this study, suggestions were made to solve these problems: Considering a sufficient number of groups in DRGs, for which French, German, or Dutch examples are helpful.…”

Designing a model for implementing diagnosis‐related groups in Iran: An action plan approach

“…According to the Chilingerian study, the primary elements of the DRGs‐based implementation action plan model in the United States are establishing a case group, determining relative cost values, Grouper Software development, training, and evaluation. The essential elements in Australia include setting a national budget to align previous activities tariffs with activities in the DRGs, publishing an AR‐DRG classification system guideline, and clearly defining the types of hospital services for DRGs reimbursement 4,12 . Australian action codes to German (OPS) and converting diagnostic codes to ICD‐10‐GM.…”

“…The system was first developed by Yale University in the late 1960s and was first used by the Department of Health for the State of New Jersey as a PPS in the late 1970s. The United States was one of the first pioneers in implementing DRGs, conducting extensive research and essential steps gradually and simultaneously with older systems 4 . The essential measures are grouping patients and determining relative values, which are the two main elements in implementing this system in the United States so that other elements are adapted from these two basic elements 3 .…”