Unit:
Κατεύθυνση Οικονομία και Διοίκηση Υπηρεσιών ΥγείαςLibrary of the Faculty of Economics and of the Faculty of Business Administration
Author:
Chatzivasili Eleni
Supervisors info:
Υφαντόπουλος Ιωάννης, Καθηγητής, Τμήμα Πολιτικής Επιστήμης και Δημόσιας Διοίκησης, Εθνικό και Καποδιστριακό Πανεπιστήμιο Αθηνών (ΕΚΠΑ)
Original Title:
Η εφαρμογή των ΚΕΝ στην Ελλάδα και η οικονομική διάσταση
Translated title:
The application of DRG in Greece and the economic perspective
Summary:
Scope: This study focuses on the analysis of the effects of the legal framework on health that was applied during the economic crisis of 2007 in Greece, focusing on the impact of the Diagnosis Related Groups (DRGs).
Methodology: This study was conducted in the period of 2017-2019 as well as the bibliography research. For this study data requested and analyzed for the appliance of DRGs in the University Hospital of Heraklion (PA.G.N.I.) in Crete. Moreover, datasets are analyzed regarding the health expenditures and the average length of stay in hospitals for Greece from the World Bank and the World Health Organization in the period 1990-2016. As economic basis it is referred the constant 2011.
Results: The legal framework that was applied during the economic crisis resulted in the rationalization of the expenditures in the health sector. The consolidation of the social insurance organizations lead to the reduction on the management cost and a better market of health services. The electronic prescribing significantly decreased the amount of medical procedures, while interventions in the medicine market further decreased the relevant prices. The introduction of DRGs in the hospitals derived the gradual reduction of the average length of stay per patient and more efficient use of the available hospital beds. However, there is still a significant deviation in some DRG codes where the hospitalization days are systematically exceeded, resulting in increased treatment costs compared with the predicted ones. Moreover, there are interesting variations in the application of DRG between the different medical sectors.
Conclusion: The introduction of DRGs drastically reduced the average length of stay in hospitals for all patient categories. In the case study of PA.G.N.I. this policy resulted in the small reduction of the length of stay and its stabilization thereafter, until 2016.
However, there is a steady deviation in discharges compared to the predicted DRG hospitalization days of 31%-43% throughout the period 2011-2016. This fact affects the hospitalization costs that are increased by 14%-27%. So far this cost has been borne by the EOPYI, but this is expected to change in the future and to be in line with existing legislation that stipulates that the patient is obligated to pay the excess amount due to the variation of the money provided by DRG. In a total of about 600 examined codes, 160 codes are identified with significant revenue divergence (> 30%), while 46 of them diverge regularly almost every year. This is either due to the poor performance of the health care services or a fallible estimation of the DRGs costs. The improvement of both these factors is considered imperative for the continuation of the reform. Also, the teaching factor seems to affect several parameters of DRGs and every medical sector (i.e. pathological, surgical, etc.) exhibits different characteristics.
Main subject category:
Social, Political and Economic sciences
Keywords:
legal framework, DRG, average length of stay, economic crisis, health expenditures, Greece
