title: Introducing Diagnosis-Related Groups in Kazakhstan: Evolution, achievements, and challenges.
abstract: In 2012, Kazakhstan introduced Diagnosis-Related Groups (DRGs), as part of a package of reforms which sought to contain costs and to improve efficiency and transparency in the health system; but the main challenge was to design and implement a DRG system in just one year. In 2011-2012, Kazakhstan developed its own DRG system. Initially 180 DRGs were defined to group inpatient cases but this number was subsequently expanded to more than 400. Because of time limits, the cost weights had to be derived in the absence of existing standard hospital cost accounting systems, and a national patient data transfer system also needed developing. Most importantly, huge efforts were needed to develop a regulatory framework and build up DRG capabilities at a national level. The implementation of DRGs was facilitated by strong political will for their introduction as part of a coherent package of health reforms, and consolidated efforts to build capacity. DRGs are now the key payment mechanism for hospitals. However the reforms are not fully institutionalized: the DRG structure is continuously being refined in a context of data limitations, and the revision of cost weights is most affected by insufficient data and the lack of standardized reporting mechanisms. Capacity around DRG coding is also still being developed. Countries planning to introduce DRG systems should be aware of the challenges in moving too quickly to implement DRGs as the main hospital reimbursement mechanism.
authors: Oxford Policy Management Ltd., 6 St Aldates Courtyard, 38 St Aldates, Oxford OX1 1BN, United Kingdom.
authors: Tata
authors: T
authors: Chanturidze
authors: Oxford Policy Management Ltd., 6 St Aldates Courtyard, 38 St Aldates, Oxford OX1 1BN, United Kingdom.
authors: Mike
authors: M
authors: Esau
authors: SwissDRG AG, Haslerstrasse 21, CH-3008 Bern, Switzerland.
authors: Simon
authors: S
authors: Hölzer
authors: European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1 H 9SH, United Kingdom. Electronic address: erica.richardson@lshtm.ac.uk.
authors: Erica
authors: E
authors: Richardson
mesh_terms: D000124:Achievement; D057191:Capacity Building / Q000191:economics*; D003953:Diagnosis-Related Groups / Q000191:economics*; D018166:Health Care Reform; D006291:Health Policy; D017721:Hospital Costs; D006801:Humans; D007623:Kazakhstan; D012051:Reimbursement Mechanisms / Q000191:economics; D013997:Time Factors
keywords: DRG payment; Health care reform; Hospital; Inpatient care; Kazakhstan; Payment reforms