Building a Performance Management System for Hospitals Based on Diagnosis-Related Group (DRG) Payment

Zhao, Suping; Gu, Yingying; Huang, Zhenju

doi:10.1155/2022/7001423

Cited by 3 publications

(3 citation statements)

References 18 publications

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“… 17 It sent a strong signal to those hospitals whose cities were not among the national pilots but then decided to implement the DRG payment system. On the one hand, it may have encouraged hospitals to change their management approaches to pursue a more positive adaption of the new payment method, such as by managing medical performance based on DRG data, 18 improving information levels 19 and strengthening the quality of diagnoses coding. 20 Such measures can provide an early foundation for the formal implementation of the DRG payment system.…”

Section: Introductionmentioning

confidence: 99%

Differences in inpatient performance of public general hospitals following implementation of a points-counting payment based on diagnosis-related group: a robust multiple interrupted time series study in Wenzhou, China

Zhu,

Chen,

Zhang

et al. 2024

BMJ Open

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ObjectivesThis study measures the differences in inpatient performance after a points-counting payment policy based on diagnosis-related group (DRG) was implemented. The point value is dynamic; its change depends on the annual DRGs’ cost settlements and points of the current year, which are calculated at the beginning of the following year.DesignA longitudinal study using a robust multiple interrupted time series model to evaluate service performance following policy implementation.SettingTwenty-two public general hospitals (8 tertiary institutions and 14 secondary institutions) in Wenzhou, China.InterventionThe intervention was implemented in January 2020.Outcome measuresThe indicators were case mix index (CMI), cost per hospitalisation (CPH), average length of stay (ALOS), cost efficiency index (CEI) and time efficiency index (TEI). The study employed the means of these indicators.ResultsThe impact of COVID-19, which reached Zhejiang Province at the end of January 2020, was temporary given rapid containment following strict control measures. After the intervention, except for the ALOS mean, the change-points for the other outcomes (p<0.05) in tertiary and secondary institutions were inconsistent. The CMI mean turned to uptrend in tertiary (p<0.01) and secondary (p<0.0001) institutions compared with before. Although the slope of the CPH mean did not change (p>0.05), the uptrend of the CEI mean in tertiary institutions alleviated (p<0.05) and further increased (p<0.05) in secondary institutions. The slopes of the ALOS and TEI mean in secondary institutions changed (p<0.05), but not in tertiary institutions (p>0.05).ConclusionsThis study showed a positive effect of the DRG policy in Wenzhou, even during COVID-19. The policy can motivate public general hospitals to improve their comprehensive capacity and mitigate discrepancies in treatment expenses efficiency for similar diseases. Policymakers are interested in whether the reform successfully motivates hospitals to strengthen their internal impetus and improve their performance, and this is supported by this study.

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Section: Introductionmentioning

confidence: 99%

Differences in inpatient performance of public general hospitals following implementation of a points-counting payment based on diagnosis-related group: a robust multiple interrupted time series study in Wenzhou, China

Zhu,

Chen,

Zhang

et al. 2024

BMJ Open

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“…DRG is considered an important alternative to the conventional FFS payment method in the current trend of medical system reform (Böcking et al., 2005; Cots et al., 2011; Mihailovic et al., 2016; Roland & Olesen, 2016; Zou et al., 2020). For example, in recent years, China is planning and implementing its latest reform of MIPS to DRG and other variants of DRG, which is considered the most thorough reform for decades in health care (Liu et al., 2017; Wang et al., 2014; Zhao et al., 2018; Zhao et al., 2022). In general, the trend of MIPS reform has shifted from a single payment system to a hybrid payment system (Liu et al., 2017).…”

Section: Introductionmentioning

confidence: 99%

“…For instance, in Japan, outpatient payments are based on FFS, and inpatient payments are based on FFS in combination with DRG (Annear et al., 2018). Nowadays, there are more than 40 countries in the world using DRG and other variants of DRG, and the number of DRG versions is over 25 (Annear & Xu, 2015; Briestensky & Kljucnikov, 2021; Zhao et al., 2022).…”

Section: Introductionmentioning

confidence: 99%

The impact of medical insurance payment systems on patient choice, provider behavior, and out‐of‐pocket rate: Fee‐for‐service versus diagnosis‐related groups

et al. 2023

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The medical insurance payment system (MIPS) is a key mechanism to ensure the public's access to medical services. In a game‐theoretic model, we examine the impact of two MIPSs, fee‐for‐service (FFS) and diagnosis‐related groups (DRG), on patient choices, provider behavior, and out‐of‐pocket rate. We find that neither FFS nor DRG can dominate the other in all three aspects: social welfare, provider profit, and total patient surplus. In particular, under DRG, the out‐of‐pocket rate for patients is lower, and the total patient surplus is higher than that under FFS. However, patients with lower illness severity tend to not participate in DRG, while FFS can make all patients participate in the program. Furthermore, when the marginal cost of medical services is high, the profit of the provider and social welfare under DRG is higher than those under FFS, otherwise lower. After interviewing hospital leaders, we further investigate two extended (pilot) payment systems: DRG with two price groups, and the hybrid model incorporating both FFS and DRG. We find that both models contribute to improving provider behavior, making more patients choose the provider, but are still not perfect payment systems due to lower provider profit or social welfare. Our findings offer important insights for policymakers regarding implementing medical insurance reform in practice.

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A Bibliometric Analysis of Diagnosis Related Groups from 2013 to 2022

Lang¹,

Guo²,

Li³

et al. 2023

RMHP

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Purpose As an important management method of the global healthcare system, diagnosis related groups (DRGs) classify patients into different cost groups and pay more attention to the equitable distribution of medical resources and the quality of medical services. At present, most countries have used DRGs to help medical institutions and doctors to treat patients more accurately, avoid the waste of medical resources, and improve treatment efficiency. Methods The Web of Science database was searched to collect all relevant literature on DRGs from 2013 to 2022. The literature information was imported into CiteSpace, Vosviewer, and Histcite for data analysis and visualization of the results. Analyze the cooperative relationship among the countries, institutions, journals, and authors. The usage trend of keywords; Highlight the content of the cited articles. Results The number of articles published in this decade was stable, and the number of citations in 2014 was the highest. The United States and Germany, as the first countries to use the DRGs system, are ahead of other countries in terms of the number and quality of articles. We have carried out content research on the articles with high citations, and summarized the application range of DRGs; classification method; advantages and disadvantages of the application. In general, the development trend of DRGs in foreign countries is to continuously optimize the classification method, expand the scope of application, and improve the application effect. These provide support and reference for the improvement of medical services and the perfection of the medical insurance system. Conclusion The application of DRGs can improve the quality and efficiency of medical services, and reduce the waste of medical expenses. It can also promote the rational allocation of medical resources and the equity of medical services. In the future, DRGs will pay more attention to the personalized diagnosis and treatment and fine management of patients, and the sharing and standardization of medical data, to promote the development of medical informatization.

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Building a Performance Management System for Hospitals Based on Diagnosis-Related Group (DRG) Payment

Cited by 3 publications

References 18 publications

Differences in inpatient performance of public general hospitals following implementation of a points-counting payment based on diagnosis-related group: a robust multiple interrupted time series study in Wenzhou, China

Differences in inpatient performance of public general hospitals following implementation of a points-counting payment based on diagnosis-related group: a robust multiple interrupted time series study in Wenzhou, China

The impact of medical insurance payment systems on patient choice, provider behavior, and out‐of‐pocket rate: Fee‐for‐service versus diagnosis‐related groups

A Bibliometric Analysis of Diagnosis Related Groups from 2013 to 2022

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