Hospital payment systems based on diagnosis-related groups: experiences in low- and middle-income countries

Mathauer, Inke; Wittenbecher, Friedrich

doi:10.2471/blt.12.115931

Cited by 172 publications

(200 citation statements)

References 21 publications

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“…However, in order to minimise bias and error, 20% of abstracts were independently screened by another author. 4 Thereafter, health service providers receive a fixed payment based on the cluster each patient is allocated to, with clusters with higher expected HSU generating higher payments than those with lower expected HSU. 5 Paying providers fixed payments based on 'clustering' of treated patients allows policymakers to distribute resources in a systematic and equitable manner.…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review of the Predictors of Health Service Utilisation by Adults with Mental Disorders in the UK

Twomey

Baldwin

Hopfe

et al. 2015

European Psychiatry

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Objectives: To identify variables that predict health service utilisation (HSU) by adults with mental disorders in the UK, and to determine the evidence level for these predictors.Design: A narrative synthesis of peer-reviewed studies published after the year 2000. The search was conducted using four databases (ie, PsycINFO, CINAHL Plus with full text, MEDLINE and EMBASE) and completed on 25 March 2014. Setting:The majority of included studies were set in health services across primary, secondary, specialist and inpatient care. Some studies used data from household and postal surveys.Participants: Included were UK-based studies that predicted HSU by adults with mental disorders. Participants had a range of mental disorders including psychotic disorders, personality disorders, depression, anxiety disorders, eating disorders and dementia.Primary outcome: A wide range of HSU outcomes were examined, including general practitioner (GP) contacts, medication usage, psychiatrist contacts, psychotherapy attendances, inpatient days, accident and emergency admissions and 'total HSU'.Results: Taking into account study quality, 28 studies identified a range of variables with good preliminary evidence supporting their ability to predict HSU. Of these variables, comorbidity, personality disorder, age (heterogeneous age ranges), neurotic symptoms, female gender, a marital status of divorced, separated or widowed, non-white ethnicity, high previous HSU and activities of daily living, were associated with increased HSU. Moreover, good preliminary evidence was found for associations of accessing a primary care psychological treatment service and medication use with decreased HSU.

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Section: Introductionmentioning

confidence: 99%

A Systematic Review of the Predictors of Health Service Utilisation by Adults with Mental Disorders in the UK

Twomey

Baldwin

Hopfe

et al. 2015

European Psychiatry

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“…1 In many low/middle-income countries fee-for-service may be the dominant payment method for reimbursing provider but there are moves to adopt diagnosis-relatedgrouping (DRG) payment as part of measures to address the negative incentives of fee-for-service payment. 16 In Ghana, the NHIA initially adopted fee-for-service payment but switched to DRG payment following the observed negative incentives that the fee-for-service created in the system. DRG provides means for relating diagnosis and treatment to cost.…”

Section: Considerations Underlying Provider Paymentmentioning

confidence: 99%

“…16 In Ghana DRG rates are fixed in advance for a given diagnosis or diagnosis cluster but the reimbursement is made after the services have been rendered. Upon realization that the DRG creates incentives for providers to "game" the National Health Insurance Scheme (NHIS) the NHIA in Ghana is exploring capitation payment for primary care.…”

Section: Considerations Underlying Provider Paymentmentioning

confidence: 99%

A narrative synthesis of illustrative evidence on effects of capitation payment for primary care: lessons for Ghana and other low/middle-income countries

Andoh-Adjei¹,

Spaan²,

Asante³

et al. 2017

Ghana Medical Journal

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SUMMARYObjective: To analyse and synthesize available international experiences and information on the motivation for, and effects of using capitation as provider payment method in country health systems and lessons and implications for low/middle-income countries. Methods: We did narrative review and synthesis of the literature on the effects of capitation payment on primary care. Results: Eleven articles were reviewed. Capitation payment encourages efficiency: drives down cost, serves as critical source of income for providers, promotes adherence to guidelines and policies, encourages providers to work better and give health education to patients. It, however, induces reduction in the quantity and quality of care provided and encourages skimming on inputs, underserving of patients in bad state of health, "dumping" of high risk patients and negatively affect patient-provider relationship. Conclusion:The illustrative evidence adduced from the review demonstrates that capitation payment in primary care can create positive incentives but could also elicit un-intended effects. However, due to differences in country context, policy makers in Ghana and other low/middle-income countries may only be guided by the illustrative evidence in their design of a context-specific capitation payment for primary care.

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“…Since the 1990s, most developed countries have introduced a DRG-based payment system for hospitalized patients (11). The primary aim in introducing DRG systems is to increase the efficiency and transparency of hospital services (16). With DRG systems of classification, the costs of diagnostic procedures and treatments are pre-defined within a certain scale for a given DRG group (17,18).…”

Section: Diagnosis-related Groupsmentioning

confidence: 99%

Possible Uses of Data from Hospital Discharge Reports

Kocić

Vasiljevic

Radovanovic

et al. 2017

Serbian Journal of Experimental and Clinical Research

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Hospital payment systems based on diagnosis-related groups: experiences in low- and middle-income countries

Cited by 172 publications

References 21 publications

A Systematic Review of the Predictors of Health Service Utilisation by Adults with Mental Disorders in the UK

A Systematic Review of the Predictors of Health Service Utilisation by Adults with Mental Disorders in the UK

A narrative synthesis of illustrative evidence on effects of capitation payment for primary care: lessons for Ghana and other low/middle-income countries

Possible Uses of Data from Hospital Discharge Reports

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