[Employment of WHO criteria for the assessment of provider payment systems in diagnosis related groups].
The concept of Diagnosis Related Groups (DRGs) is a well-established provider payment system for in-patient institutions. While the original aims of the system were to reduce costs as well as to increase quality and benefit of health care, the emphasis has progressively shifted to cost reduction, leaving the quality-oriented parameters in a secondary role. A major part of any patient-classification system is the pricing practice used to define the revenues for each patient group on the basis of single cases. To estimate the effects of different cost accounting methods on health care quality, we designed a new assessment system based on the employment of a WHO approach to compare different provider payment systems. The designed system is based on six different parameters recommended by the WHO: integration of patients' health risk into pricing practice, incentives for quality improvement and innovation, availability of high-class evidence-based therapy, prohibition of economically-founded exclusions, reduction of fragmentation incentives, and improvement of patient-oriented treatment. This assessment system enables the investigation of calculation processes of different patient-classification systems (and of provider payments in general), in view of their impact on quality.
Leister
Jan Eric
JE
Institut für Medizinische Informatik, Biometrie und Epidemiologie Universitätsklinikum Essen, Essen.
Stausberg
Jürgen
J
D003953:Diagnosis-Related Groups / Q000191:economics* / Q000592:standards*; D006801:Humans; D011785:Quality Assurance, Health Care; D012051:Reimbursement Mechanisms; D014944:World Health Organization