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DRG implementation in Estonian health care model – hospital perspective Teele Orgse 4th Nordic...
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Transcript of DRG implementation in Estonian health care model – hospital perspective Teele Orgse 4th Nordic...
DRG implementation in Estonian health care model –
hospital perspective
Teele Orgse
4th Nordic Casemix Conference
June 4th 2010 Helsinki
The Republic of Estonia
• Parliamentary republic, president elected for 5 years (Mr. Toomas Hendrik Ilves)
• Official language – Estonian• Coastline – 3794 km with 1521 islands• Total area – 45 227 km2 • Population – 1 370 000 (Estonians 65%,
Russians 28%, Ukrainians 3%, Belorussians 1%, Finns 1%, other 2%)
• Independent since 24.02.1918, occupied by the Soviet Union 1940, regained the independence on 20.08.1991. Member of the European Union since May 1st 2004.
• We have been here since 6500 BC!
Background – Soviet heritage
• Centralized
• state-controlled
• over-capacitated provider network (120 hospitals with 18 000 beds)
• Polyclinics
• budget financed
Background - reforms• Began in the end of 1980s• Economic collapse, high inflation and political
clutter – the aim was:– to improve the efficiency and quality of health care
system
– to meet the needs of a small country and its population
• Decentralization of primary and hospital care to local administrative level
• Elimination of special systems• Separation of powers• January 1st 1992: Health Insurance Law
– From tax-based to insurance-based
• Hospital network reorganization• Health care providers – operating under
private law
Financing
Earmarked payroll tax
13%66%
Central government
9%
Municipalities1%
Co-payment21%
Others3%
ContractingNeed
assessment
Quarterlyassessment
Designing ofbudget Contracting
4-year financialprognosis
The most cost-efficient system in Europe because of the contracting system. The supreme winner in the 2007 and 2008 BFB (bang-for-the-buck) scores (Euro Health Consumer Index 2008 report).
Health care services list
• Calculated by the EHIF, consulted with specialists and hospitals
• Over 130 pages
• Lists every
detailed service
– coded + priced
The BILL
• Fee-for-service:– Service + service + service = € € €
• Hospitals analyse and manage contracts
• Capped contracts
DRG-s in Estonia
• Implemented in 2004
• There were a few articles about what DRGs are (Habicht)
• Some presentations
• “Somehow infiltrated”
• Starting from 10%/90% to 70%/30% today
The BILL
• Fee-for-service:– Service + service + service = € € €
• Hospitals analyse and manage contracts
• Capped contracts
• Bill = services 30% +DRG price 70%
Hospital “study”• 2 hospitals regularly analyze the impact of
DRGs• 1 hospital uses special program – Datawell
Visual DRG Pro• 7 years after implementation basic
calculation principles still need to be introduced
• EHIF finances over 90% of the hospital budget– Pärnu Hospital 10,2 M € (45%)– 70% 7,1M €
Correcting
• Is labour with suturation still labour or is it a complication?
• Is a chronically ill heart failure patient a heart failure patient or a patient with heart rhytm problems?
• Is stenocardia the main problem or is morbus ischaemicus cordis?
Classification
• Official guidelines:– Gynecology and obstetrics 2005– Hematology 2006
• ICD-10– Doctors education– “Most resourceful diagnose”
• Better statistics if dealth with
Case study - Pärnu Hospital
• Around 15 000 bills that concern DRG– 2 300 don’t classify– Over 50% of bills are covered by
22 DRGs
Are prices fair?
2005 – 2006 101%
2006 – 2007 101%
2007 – 2008 119%
2008 – 2009 101%
2009 - 2010 101%
DRG 182
• 2006-2010 DRG billing in infectious diseases department always negative
• DRG 182 one of the most usual (1-3)• 01.01.2010– 21.05.2010 42 cases
- negative financial aspect 44 710 EEK- negative 19- positive 23
• Negative in cases with over 5 days admission
DRG 225
• 2006-2010 DRG billing in orthopedics department always negative
• DRG 225 one of the most usual (4-5)• 01.01.2010– 21.05.2010 16cases
- negative financial aspect 29 269 EEK- negative 13 - positive 3
• Negative in higher class operations
Conclusion• DRGs are part of hospital
financing system
• Hospitals don’t have resources or will or know-how or a reason to analyze
• Made the system less transparent
• There is so much information that could be used and we are moving towards that