Χαράλαμπος Οικονόμου, Καθηγητής, Τμήμα Κοινωνιολογίας, Πάντειο Πανεπιστήμιο
Δάφνη Καϊτελίδου, Αναπληρώτρια Καθηγήτρια, Τμήμα Νοσηλευτικής, ΕΚΠΑ
Όλγα Σίσκου, Ακαδημαϊκή Υπότροφος, Τμήμα Νοσηλευτικής, ΕΚΠΑ
The Greek health system, over time, has developed into a mixed public health system, however with several peculiarities that caused it pathogens that it is still trying to overcome. One of its structural problems is the financing of its services, in the sense of a three-pronged mixed compensation system involving the percentage contribution of the state budget, the social security, and the private sector.
The interest is focused on the introduction of Closed Greek Hospitals Costs, (KEN), as an ex ante perspective, "prospective", method of compensation of hospitals during the restructuring of the National Health System, (NHS), in Greece in 2012, an effort aimed at, on the one hand, in the more accurate pricing of the medical care, and on the other hand, in the improvement of the quality of the provided care. In this sense, the aim of the present work is twofold˙ to investigate the mechanisms and criteria for the financing of health services in Greece from the introduction of KEN until today, and consequently, to determine whether and to what extent the current methods of compensation adequately meet the real costs of hospitalization of the Physical Medicine and Rehabilitation Centers.
Therefore, the methodological approach of this working will initially move retroactively, through a wide theoretical field of knowledge that has already been developed for similar to Greek KEN mechanisms of current forms of perspective funding.
The focus is on compensation methods from which health care providers are reimbursed by insurance companies “in advance” for healthcare packages/contracts, which are evaluated on the basis of hospital performance, (effectiveness), and clinical efficiency. In essence, this is a predictable cost compensation that arises in relation to the above performance of a hospital, "payment according to performance", and reflects a predetermined level of resource use. In this sense, a widely accepted model of compensation has been developed, structured by homogeneous Diagnostic Related Groups (DRGs), whose core philosophy lies in combining the needs and composition of patients with similar diseases in relation to the productive and functional activity of hospitals.
Through the literature review, the international experience and the comparative studies of other mainly European countries so far, in matters of Physical Medicine and Rehabilitation, it will be investigated whether the current pricing of KEN, in matter of rehabilitation and recovery, which in other clinical diseases may have contributed in reducing the Medium Length of Hospitalization, in other words, Length Of Stay, and therefore, in reducing the cost of treatment, is sufficient in the way it is costed to date. Considering the existing difficulties for the implementation of a holistic model of approach to the care of patients with mobility problems, and taking into account the distinguished traits, and the particularities of their individual needs, in relation to the coexisting diseases and complications, more consistent and documented costing tools for diseases and medical practices of physical medicine and rehabilitation will be proposed.
In conclusion, the present project aims to explore through the knowledge gained so far, what would be, depending on the type, public or private, and the specific purpose of each rehabilitation unit, the most optimal reimbursement mix of interventions that could potentially better meet the needs of patients, but also, the more efficient use of physical medicine and rehabilitation units.
Diagnostic related groups, DRGs, Prospective payment, Reimbursement system, International classification of diseases, ICD, The international classification of functioning, disability and health, ICF, Rehabilitation, Funding models, Complexity, Case-mix group and rehabilitation, Inpatient rehabilitation, Bundled payments and rehabilitation