Diagnosis-related groups--application in a paediatric department.
The Diagnosis-Related Groups (DRG) system is used in the USA to classify patients on the basis of diagnosis into medically meaningful groups. The system was developed for evaluation of resource utilisation for peer review purposes. It has become better known through being utilised by Medicare, the medical insurance system for the poor in the USA, for prospective determination and payment of patient's hospitalisation costs. A pilot study to compare the costs of hospital care in a sample of the paediatric patient population at Ga-Rankuwa Hospital with the DRG weightings was undertaken to assess its application locally. A poor correlation was found. The costing studies conducted for this purpose were also used to compare resource use between units in the Department of Paediatrics, and substantial unexplained variations were found. It is concluded that the weightings used in the US DRG system cannot be directly applied to the patients at Ga-Rankuwa Hospital for billing purposes. The DRG principle, however, is feasible and has important management benefits; it is recommended that locally determined DRG weightings be developed, and that other hospitals explore their use in peer review of resource management, costing and pricing.
Hay
I T
IT
Department of Paediatrics and Child Health, Medical University of Southern Africa, Pretoria.
Ellis
J B
JB
Robertson
J
J
Jacobs
D J
DJ
Mokgabudi
A
A
D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data*; D006748:Hospital Departments / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D010372:Pediatrics; D010865:Pilot Projects; D013019:South Africa