Ardelean, Gavril - Buicu, Florin (szerk.): Satu Mare. Studii şi comunicări. Seria ştiinţele naturale 7. (2006)
Medicină
Satu Mare - Studii şi Comunicări Seria Ştiinţele Naturii Voi. VII (2006) 9.3. Results and Conclusions The Cluj case-mix project provided the first training tools and techniques regarding the usage of complete ICD 10 for coding in-patients diagnostics. This coding activity is directly related with the development and implementation of the first Romanian data collection application that is used for assignment of patients in DRG categories. The data collection application set up the basis for the new approach of collecting patient level data in electronic format (for a minimum data set of information). This approach is regarded now as one of the next step of the health care reform in Romanian hospitals. The patient level costing methodology described was used from the beginning of the project and provided the first costs data at patient level. At the end of the project the process of patient level costs was improved (based on these first steps) and provided more accurate results. The calculation of the costs within a hospital is a complex and ongoing process. There were identified some place to intervene for an increased accuracy of the costs, but the resources needed are far greater. The hospital will continue to use this costing methodology as a starting point in his continuous process of calculating the patient level costs. The costing efforts done at Cluj University District Hospital were the beginning of the continuing process of calculating patient level costs, as the basis for the reimbursement of Romanian hospital according with their case-mix. Conclusion The DRG system is internationally recognized as on of the optimal system to produce case cost information in health. l ike all systems DRG has advantages and potential drawbacks. The advantages of a DRG-based system are: • better transparency of hospital system management and financing. • allow paying agencies to better control the amount of money they spend in reimbursing hospitals. • help paying agencies predict well into the future what the financial payouts to hospitals will be. Potential drawbacks of a DRG payment based system are described as follows: DRGs have led to a reduction in the length of patient stay (LOS). While reduction in hospital LOS may have many benefits, most research suggests that patients are discharged “quicker and sicker” adding extra burden on an often inadequately resourced home-care infrastructure22. A recent issue of concern is DRG up coding. Up coding is when a patient diagnosis is coded as more severe or acute than is actually the case. Providers up-code in order to receive a higher reimbursement for services. This practice distorts health statistics and abuses the financing system. In the face of imposed budgetary restrictions, providers may be tempted to miscode. Measures are being developed in various countries to curb this phenomenon by creating reward systems to motivate medically correct coding23. German researchers found, however, that documentation is often insufficient to assign a DRG code24. DRG-type systems are illness and acuity focused (rewarding for treatment of an illness), often neglecting disease prevention and health promotion25. DRG payments do not distinguish between low and high dependency cases although hospital costs are greater in situations of high dependency. DRGs create a financial incentive for hospitals to avoid high-dependency patients thus threatening equity in access to health services26. In Romania, staying with the decision to implement case-based financing despite constandy changing political interests and environment has to be integrating the project with the activities of local institutions. Begin taking decisions using data and findings, which can help to overcome political changes and instability, apply pressure from all sides until improvements are seen. Next steps in implementing new financing system are to define the basic benefit packages, to introduce the private health insurance, to develop new and efficient public —private partnerships, to introduce the real global budget for restructured hospitals, to introduce the depreciation and to develop the multipurpose center. The development of hospitals DRG payment requires for the future an increased capacity of R&D in order to implement the targets established by the DRG financing strategy: 22 23 24 25 26 22 Forgione et. al. (2004). Ibid. 23ICN (2003a). ICN Workforce Forum: Overview Paper, September 2003. Diagnosis-related groups. Can be found at www.icn.ch/forum2003report.pdf. 24 Muller ML, Burkle T, Irps S, Roeder N and Prokosch H (2003). The Diagnosis Related Groups Enhanced Electronic Medical Record. International Journal of Medical Informatics, 70. 25 ICN (2003b). ICN Workforce Forum: Overview Paper. July 2003. Diagnosis-related groups. Can be found at www.icn.ch/forum2003.pdf. 26 Chuang KH, Covinsky KE, Sands LP, Fordnsky RH, Palmer RM & Landefeld S (2003). Diagnosis-Related Group - Adjusted Hospital Costs Are Higher in Older Medical Patients with Lower Functional Status. Journal of the American Geriatrics Society, 51, 12. 303
