Changing Patient Classification System for Hospital Reimbursement in Romania

Radu, Ciprian-Paul; Chiriac, Delia Nona; Vladescu, Cristian
June 2010
Croatian Medical Journal;Jun2010, Vol. 51 Issue 3, p250
Academic Journal
Aim To evaluate the effects of the change in the diagnosisrelated group (DRG) system on patient morbidity and hospital financial performance in the Romanian public health care system. Methods Three variables were assessed before and after the classification switch in July 2007: clinical outcomes, the case mix index, and hospital budgets, using the database of the National School of Public Health and Health Services Management, which contains data regularly received from hospitals reimbursed through the Romanian DRG scheme (291 in 2009). Results The lack of a Romanian system for the calculation of cost-weights imposed the necessity to use an imported system, which was criticized by some clinicians for not accurately reflecting resource consumption in Romanian hospitals. The new DRG classification system allowed a more accurate clinical classification. However, it also exposed a lack of physicians' knowledge on diagnosing and coding procedures, which led to incorrect coding. Consequently, the reported hospital morbidity changed after the DRG switch, reflecting an increase in the national case-mix index of 25% in 2009 (compared with 2007). Since hospitals received the same reimbursement over the first two years after the classification switch, the new DRG system led them sometimes to change patients' diagnoses in order to receive more funding. Conclusion Lack of oversight of hospital coding and reporting to the national reimbursement scheme allowed the increase in the case-mix index. The complexity of the new classification system requires more resources (human and financial), better monitoring and evaluation, and improved legislation in order to achieve better hospital resource allocation and more efficient patient care.


Related Articles

  • Disability-Related Categories: A Classification System for Short Term Sickness Benefits. Lambrinos, James; Johnson, William G. // Benefits Quarterly;1988 First Quarter, Vol. 4 Issue 1, p48 

    Classification systems are being used in a variety of ways to deal with the high costs of medical care. The diagnosis-related group prospective payment system for hospitals is the major effort in this regard. This study examines the possibility that a classification system can be devised for...

  • Using diagnosis-related groups. Lungen, M.; Dredge, B.; Rose, A.; Roebuck, C.; Plamper, E.; Lauterbach, K. // European Journal of Health Economics;Dec2004, Vol. 5 Issue 4, p287 

    Focuses on the system of diagnosis-related groups in the British National Health Service and Germany. Features and functions of the system of diagnosis-related groups; Implication of the system on health care operations in the countries; Hospital management's views about the system; Impact of...

  • Nursing Resources Definition in DRGs. Diers, Donna; Bozzo, Janis // Nursing Economic$;May/Jun97, Vol. 15 Issue 3, p124 

    The development of diagnosis-related groups and their acceptance for prospective payment under Medicare fundamentally changed the way hospitals think about their clinical and financial information systems. Hospitals exist to provide nursing care. But finding nursing data in hospital information...

  • Big payment changes ahead? Lubell, Jennifer // Modern Healthcare;7/31/2006, Vol. 36 Issue 30, p10 

    This article reports on various issues regarding the changes in Medicare hospital payments. The proposal issued by the Centers for Medicare and Medicaid Service contains two substantial revisions to the payment system, basing the weights of diagnosis-related groups (DRGs) on cost rather than...

  • time to replace adjusted discharges. Cleverley, William O. // hfm (Healthcare Financial Management);May2014, Vol. 68 Issue 5, p84 

    The article discusses a study which assessed Equivalent Discharges, an alternative metric for hospital volume which assumes that the Medicare severity-adjusted diagnosis related groups (MS-DRG) case weights and the Medicare ambulatory patient classification (APC) case wrights reflect underlying...

  • Direct vitamin k antagonist anticoagulant treatment health care costs in patients with non-valvular atrial fibrillation. Hidalgo-Vega, Álvaro; Askari, Elham; Vidal, Rosa; Aranda-Reneo, Isaac; Gonzalez-Dominguez, Almudena; Ivanova, Alexandra; Ene, Gabriela; Llamas, Pilar // BMC Health Services Research;2014, Vol. 14 Issue 1, p1 

    Background There is evidence suggesting that most thromboembolic complications could be prevented with adequate pharmacological anticoagulation. We estimated the direct health care costs of anticoagulant treatment with oral vitamin K antagonists in patients diagnosed with nonvalvular atrial...

  • Making the Most of DRGs. Tarantino, David // Physician Executive;Nov/Dec2002, Vol. 28 Issue 6, p50 

    Focuses on the Diagnosis Related Group (DRG) system of hospital reimbursement in the U.S. Description on the DRG system; DRG relative weight and hospital base rate factors of hospital payment; DRG coding. INSET: Coding Counts.

  • Use of diagnosis-related groups by non-Medicare payers. Carter, Grace M.; Jacobson, Peter D. // Health Care Financing Review;Winter94, Vol. 16 Issue 2, p127 

    Describes how non-Medicare third party payers for hospital care use diagnosis-related groups (DRGs) criteria and systems. Users from 21 State Medicaid programs; Workers' compensation systems; Civilian Health and Medical Program of the Uniformed Services; Blue Cross and Blue Shield Association...

  • An evaluation of diagnosis-related group severity and complexity refinement. McGuire, Thomas E. // Health Care Financing Review;Summer91, Vol. 12 Issue 4, p49 

    Examines severity class adjustment of the all-payer prospective payment system under a New Jersey project. Alternative strategies for refining diagnosis-related groups; Distribution of severity levels for study diagnosis-related groups; Computerized severity index and Yale model reports.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics