Restructuring of Gynecology-Obstetric Services Provision Based on Diagnosis-Related Groups Model

Abstract

The implementation of the Diagnosis Related Groups (DRGs) model in public hospitals in North Macedonia started in 2009. Purposes were data collection, cost management, standardization of services and budget allocation. Of all DRG-coded health services, about 25% are related to gynecology/obstetric and neonatology. Aim of this research was to investigate, analyze and evaluate possible restructuring of gynecology-obstetric services on a national level using the existing DRG model in place, focused on deliveries as a benchmark for service provision. We used the Health Insurance Fund DRG database for health services, populated online by medical professionals. Data was retrieved retrospectively for the period 2015-2019, with focus on 2018 as mid-point year. Statistical methods were used to describe the structure of the gynecology/obstetric and delivery services as per the DRG model. Results showed poor structure of the health network for organized provision of delivery service. Transfers to other health facilities (about 18%) and transfers towards tertiary health care (about 22%) showed low capacity of coping with the demand for provision of services (deliveries). Simulation model presents possible restructuring of services and improved hospitals’ efficiency.