Introducing Diagnosis-Related Groups in Kazakhstan: Evolution, achievements, and challenges

Abstract

In 2012, Kazakhstan introduced Diagnosis-Related Groups (DRGs), as part of a package of reforms which sought to contain costs and to improve efficiency and transparency in the health system; but the main challenge was to design and implement a DRG system in just one year.In 2011-2012, Kazakhstan developed its own DRG system. Initially 180 DRGs were defined to group inpatient cases but this number was subsequently expanded to more than 400. Because of time limits, the cost weights had to be derived in the absence of existing standard hospital cost accounting systems, and a national patient data transfer system also needed developing. Most importantly, huge efforts were needed to develop a regulatory framework and build up DRG capabilities at a national level.The implementation of DRGs was facilitated by strong political will for their introduction as part of a coherent package of health reforms, and consolidated efforts to build capacity. DRGs are now the key payment mechanism for hospitals. However the reforms are not fully institutionalized: the DRG structure is continuously being refined in a context of data limitations, and the revision of cost weights is most affected by insufficient data and the lack of standardized reporting mechanisms.Capacity around DRG coding is also still being developed.Countries planning to introduce DRG systems should be aware of the challenges in moving too quickly to implement DRGs as the main hospital reimbursement mechanism.

Implementation of provider payment system reforms in the age of universal health coverage: a realist review of evidence from Asian developing countries

“…These included setting up a fully-fledged user database that allowed users to change their preferred provider up to four times a year, frequent updates of user electronic registries, a referral system with gatekeeping functions that made providers financially liable to pay from their capitation budgets if they referred cases out of the provider network and a gatekeeping system that held users liable for their own health services payment should they bypass the usual chain of command from primary health facilities. 1,25 A similar situation was observed in Kazakhstan. A robust information management system with efficient transfer of patient data from the local health agencies to the central data agency was established under a highly ambitious government programme.…”

“…These measures facilitated the rapid set up and implementation of a novel DRG system in less than a year. 25…”

“…These measures facilitated the rapid set up and implementation of a novel DRG system in less than a year. 25 CMO3. Rapid expansion of PPR under a government determined to sustain its electoral success (C) resulted in a stronger commitment to empower health providers to set up supportive facilities and user-friendly environments and to attain full accreditation status (M), in order to facilitate health service quality improvement (O).…”

“…In addition, a major overhaul of health information systems nationwide allowed providers' cost efficiency to be achieved effectively. These included setting up a fully-fledged user database that allowed users to change their preferred provider up to four times a year, frequent updates of user electronic registries, a referral system with gatekeeping functions that made providers financially liable to pay from their capitation budgets if they referred cases out of the provider network, and a gate-keeping system that held users liable for their own health services payment should they bypass the usual chain of command from primary health facilities (1,25). A similar situation was observed in Kazakhstan.…”

Effects of a DRG-based hospital reimbursement on the health care utilization and costs in Swiss primary care: A retrospective “quasi-experimental” analysis

“…Most research has focused on (inpatient) care in hospitals rather than outpatient care [ 11 ]. Accordingly, there is little data on primary care, especially about the outpatient care sector, which affect the consultations [ 4 , 23 – 25 ]. Additionally, only a minority of articles presented empirical data, and most of them are not 'evidence-based' [ 26 ].…”