Search Results (5)

Background/Objectives: Diagnosis-related group (DRG)-based financing, a subcategory of case-based payment models, has been established as the primary reimbursement scheme in most high-income countries. Almost 40 years thereafter, the impact of the reform on gynecologic oncology funding and recompensation has not been clearly elucidated. This systematic review aims to address the scarce bibliographic data, consolidate the information regarding DRG-based systems in gynecologic oncology, evaluate the advantages and challenges of its implementation worldwide, and examine alternative and complementary recompensation schemes in this context. Methods: A stringent and comprehensive literature review of original articles using online databases (Google Scholar and Pubmed) yielded 173 potential results. Results: These were further assessed for relevance and eligibility and, finally, an in-depth investigation of 15 articles was conducted. We concluded that, despite the fact that DRG-based financing may be beneficial in most healthcare scenarios, the reimbursement scheme is challenged in the context of gynecologic oncology. Conclusions: An innovative approach comprising a combination of the values of case-based and value-based payment models would extend healthcare services beyond acute treatments and propose new perspectives in holistic healthcare provision in a financially sustainable environment. Full article

The emphasis on value-based payment models for primary total hip replacement (THA) results in a greater need for orthopaedic surgeons and hospitals to better understand actual costs and resource use. Time-Driven Activity-Based Costing (TDABC) is an innovative approach to measure expenses more accurately and address cost challenges. It estimates the quantity of time and the cost per unit of time of each resource (e.g., equipment and personnel) used across an episode of care. Our goal is to understand the true cost of a THA using the TDABC in an Italian public hospital and to comprehend how the adoption of this method might enhance the process of providing healthcare from an organizational and financial standpoint. During 2019, the main activities required for total hip replacement surgery, the operators involved, and the intraoperative consumables were identified. A process map was produced to identify the patient’s concrete path during hospitalization and the length of stay was also recorded. The total inpatient cost of THA, net of all indirect costs normally included in a DRG-based reimbursement, was about EUR 6000. The observation of a total of 90 patients identified 2 main expense items: the prosthetic device alone represents 50.4% of the total cost, followed by the hospitalization, which constitutes 41.5%. TDABC has proven to be a precise method for determining the cost of the healthcare delivery process for THA, considering facilities, equipment, and staff employed. The process map made it possible to identify waste and redundancies. Surgeons should be aware that the choice of prosthetic device and that a lack of pre-planning for discharge can exponentially alter the hospital expenditure for a patient undergoing primary THA. Full article

(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. Full article

The National Health Insurance Administration of Taiwan has implemented global budget payments, the Diagnosis-Related Group (DRG) inpatient diagnosis-related group payment system, and the same-disease payment system, in order to decrease the financial burden of medical expenditure. However, the benefit system reduces the income of doctors and hospitals. This study proposed an early warning payment algorithm that applies data analytics technology to diabetes hospitalization- and treatment-related fees. A model was constructed based on the characteristics of the Exponentially Weighted Moving Average (EWMA) algorithm to develop control charts, which were first employed using the 2001–2017 health insurance statistical database released by the Department of Health Insurance (DHI). This model was used to simulate data from inpatients with diabetes, to create an early warning algorithm for diagnosis-related groups’ (DRGs’) medical payments as well as to measure its accuracy. This study will provide a reference for the formulation of payment policies by the DHI. Full article

The study provides evidence of the governance and its context according to the introduction of the New Diagnosis-Related Groups (DRGs)-based payment system in Korea. In-depth interviews with 14 core policy elites from four health areas were conducted. As governance is a multidimensional concept, interviewees were asked to evaluate different dimensions based on the World Bank’s five elements (Coherent decision-making structures, Consistency and Stability, Stakeholder participation, Supervision and Regulation, and Transparency and Information). Overall, the new payment system was perceived as poorly governed. Since its introduction, it has not offered a new governance perspective because it used a conventional top-down approach, while political windows for cooperation were not wide open. Of the five governance dimensions, the scores were lowest in Stakeholder participation. There was a large perception gap between physicians and government officers here. Participants from academia perceived Consistency and Stability as ineffectively governed. In the meantime, the government has mainly created health policy in Korea. As a result, stakeholder participation, especially the participation of medical personnel, has been insufficient in the process of health policy formulation. The study suggests that the decision-making process in health policy needs to be more participatory and reliable, with governance regarded as a high priority. Full article