Investigating DRG cost weights for hospitals in middle income countries

Abstract

Identifying the cost of hospital outputs, particularly acute inpatients measured by Diagnosis Related Groups (DRGs), is an important component of casemix implementation. Measuring the relative costliness of specific DRGs is useful for a wide range of policy and planning applications. Estimating the relative use of resources per DRG can be done through different costing approaches depending on availability of information and time and budget. This study aims to guide costing efforts in Iran and other countries in the region that are pursuing casemix funding, through identifying the main issues facing cost finding approaches and introducing the costing models compatible with their hospitals accounting and management structures. The results show that inadequate financial and utilisation information at the patient's level, poorly computerized 'feeder systems'; and low quality data make it impossible to estimate reliable DRGs costs through clinical costing. A cost modelling approach estimates the average cost of 2.723 million Rials (Iranian Currency) per DRG. Using standard linear regression, a coefficient of 0.14 (CI = 0.12-0.16) suggests that the average cost weight increases by 14% for every one-day increase in average length of stay (LOS).We concluded that calculation of DRG cost weights (CWs) using Australian service weights provides a sensible starting place for DRG-based hospital management; but restructuring hospital accounting systems, designing computerized feeder systems, using appropriate software, and development of national service weights that reflect local practice patterns will enhance the accuracy of DRG CWs.

Designing a balanced scorecard for a tertiary care hospital in Pakistan: a modified Delphi group exercise

“…Similar issues of patient data records have been reported from Ethiopian hospitals (Hartwig et al, 2008). Moreover it has been shown in Iran that hospitals are collecting a lot of financial and clinical information in a fairly computerized but not in a well-organized format (Ghaffari et al, 2008). A need for an electronic patient record system (an e-health initiative) was, therefore, emphasized to overcome some of these methodological barriers and come up with more robust indicators in our setting.…”

Hospital costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition

“…Moreover, this system ensures that the hospital’s total costs are distributed among the patients. Allocation was based on directly assigning the cost of the following services to the patient: laboratory, pharmacy, radiology, nuclear medicine, pathology, and prosthetics [17,18]. The information systems contain exhaustive data on human resources and their activity: storage, admissions planning, ambulatory and emergency care, operating rooms, diagnostic and complementary tests, and inter-hospital consultations.…”

Reforming reimbursement of public hospitals in Greece during the economic crisis: Implementation of a DRG system

“…The German classification is based on the Australian Refined DRG (AR-DRGs) system, which in turn evolved from the Australian National DRG system and has been a common starting place for other countries embarking on the implementation of a DRG system [25]. In addition, the German (G-DRG) system has been recently implemented and shares common problems with Greece such as hospital overcapacity and lack of demand-driven service allocation [26].…”