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The DRG Story: Transition to Europe and Beyond

The DRG Story: Transition to Europe and Beyond. Miriam Wiley The Economic and Social Research Institute Dublin, Ireland.

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The DRG Story: Transition to Europe and Beyond

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  1. The DRG Story:Transition to Europe and Beyond Miriam Wiley The Economic and Social Research Institute Dublin, Ireland

  2. “The US health care system … is…a conspicuous failure..And yet American ideas-notably notions of competition-have been influential in a range of European countries. And American policy tools-for example,diagnosis-related groups-based systems of remuneration have been adopted.”Rudolf Klein, AJPH, Jan 2003, Vol 93, No.1, p.63

  3. Factors influencing dissemination of DRGs internationally • DRGs used on a national basis in US • DRGs first case mix management system to make transition from research to policy • National relevance could be assessed empirically Kimberly & de Pouvourville, 1993

  4. Factors influencing dissemination of DRGs internationally (contd.) • Technology for using DRGs readily available at an affordable price • Consultation and technical assistance available from developers • DRGs flexible classification scheme • Refined DRGs required minimal additional investment Kimberly & de Pouvourville, 1993

  5. Gateways to Europe and Australia • Late 1970’s Bob Fetter spent a sabbatical at the Catholic University of Louvain (with Jan Blanpain) • 1979 French task force visit to Yale (following contact between Jean de Kervasdoue and John Kimberly) and in 1982 PMSI established after further Yale research visit • 1982 George Palmer (University of New South Wales) was a Visiting Professor at Yale University School of Management

  6. Health Policy Context Technical Context Path of Entry Fate of DRGs Role of Key Constituents Effectiveness of Champions Internal & External Networks of Support Kimberley & de Pouvourville, 1993

  7. Milestones • 1983 introduction of US PPS legislation • 1984 meeting in Paris of representatives of 5 European countries interested in pursuing DRG-related research (France, Portugal, the Netherlands, Belgium, Ireland) • 1986 London conference following which PCS/E officially inaugurated • 1988 Sydney conference bringing together researchers and policy experts from Europe, Australian and US

  8. Geographical Penetration by early 1990’s • By 1991, Portugal and Norway committed to using DRGs at the national level • Belgium, England, Finland, France, Italy, Spain, Sweden, Switzerland, Ireland involved in testing DRG applications • Germany and Denmark considered DRGs unsuitable for local use (subsequently reversed)

  9. Evolution Testing Localisation? Applications AN DRGs, HRGs 1983 1993 2003 Data Coding Costing

  10. “For the outside world, the US health care scene is [therefore] a kind of supermarket where they can shop selectively. But having shopped, they also adapt…the crucial element is the local environment and context-and the extent to which imports fit, or can be made to fit, local needs” Rudolf Klein, AJPH, Jan 2003, Vol 93, No.1, p.63

  11. ‘European’ Case Mix Classification System? ‘National’ Case Mix Classification Systems? Coding Systems?

  12. Case-Mix Classification Schemes Coding Schemes for Diagnoses & Procedures

  13. ‘Other’ Case-Mix Systems • LeistungsorientierteKrankenanstaltenfinanzierung (LKF) (Austria) • Health Resource Groups (HRGs) (England) • Diagnose Behandelings Combinatie (DBC) (The Netherlands) • Nord DRGs (The Nordic Countries) • G-DRGs (Germany) • Groupes Homogenes de Malades (GHM) (France)

  14. “… the innovation process virtually guarantees that change, not stability, is the norm and thus suggests that one should expect change in products as they mature”Kimberley and de Pouvourville, 1993

  15. Overview • The ‘DRG approach’ now used throughout Western, Central and Eastern Europe, Australia, Asia, South Africa, North, Central and South America

  16. Overview (contd.) • An Australian ‘footprint’ now evident alongside the original US model in many international applications • Increasingly development/adaptation of ‘national’ systems more in evidence as data, expertise and technology available become more advanced.

  17. Overview (contd.) • While the application of case-mix measures varies between countries, these initiatives have generally had significant implications in a number of areas, including the development of high quality activity and cost information systems, technology transfer and software adaptation/development.

  18. “.... the point of irreversibility has been reached.. [this] irreversibility is lodged not in the DRGs per se but rather in the underlying logic. We believe that a significant shift has taken place in the way all parties to the health care process think about the products of the hospital, patterns of resource consumption within the hospital, and the way in which the production process should be monitored.” (Kimberley 1993)

  19. Penetration of DRG/DRG-Type Applications

  20. The Ongoing Challenge • Given the dynamic nature of health/hospital systems, the development of case-mix measures must be continually advanced to ensure that these techniques are responsive to increasing demands from innovation in technology and information systems, rising consumer expectations and the globalisation of service provision within the health care sector

  21. The ‘DRG’ Journey Continues – ENJOY!

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