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DRG implementation in Estonian health care model

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Title: Slide 1 Author: Jaak Poom Last modified by: MarttiV Created Date: 9/29/2004 8:55:48 AM Document presentation format: N yt ss katseltava diaesitys (4:3) – PowerPoint PPT presentation

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Title: DRG implementation in Estonian health care model


1
DRG implementation in Estonian health care model
hospital perspective
  • Teele Orgse
  • 4th Nordic Casemix Conference
  • June 4th 2010 Helsinki

2
The Republic of Estonia
  • Parliamentary republic, president elected for 5
    years (Mr. Toomas Hendrik Ilves)
  • Official language Estonian
  • Coastline 3794 km with 1521 islands
  • Total area 45 227 km2
  • Population 1 370 000 (Estonians 65, Russians
    28, Ukrainians 3, Belorussians 1, Finns 1,
    other 2)
  • Independent since 24.02.1918, occupied by the
    Soviet Union 1940, regained the independence on
    20.08.1991. Member of the European Union since
    May 1st 2004.
  • We have been here since 6500 BC!

3
Background Soviet heritage
  • Centralized
  • state-controlled
  • over-capacitated provider network (120 hospitals
    with 18 000 beds)
  • Polyclinics
  • budget financed

4
Background - reforms
  • Began in the end of 1980s
  • Economic collapse, high inflation and political
    clutter the aim was
  • to improve the efficiency and quality of health
    care system
  • to meet the needs of a small country and its
    population
  • Decentralization of primary and hospital care to
    local administrative level
  • Elimination of special systems
  • Separation of powers
  • January 1st 1992 Health Insurance Law
  • From tax-based to insurance-based
  • Hospital network reorganization
  • Health care providers operating under private
    law

5
Hospital Master Plan
  • Regionalism
  • Golden Circle

6
Financing
7
Contracting
Need assessment
4-year financial prognosis
Quarterly assessment
Designing of budget
Contracting
The most cost-efficient system in Europe because
of the contracting system. The supreme winner in
the 2007 and 2008 BFB (bang-for-the-buck) scores
(Euro Health Consumer Index 2008 report).
8
Contract
9
Health care services list
  • Calculated by the EHIF, consulted with
    specialists and hospitals
  • Over 130 pages
  • Lists every
  • detailed service
  • coded priced

10
The BILL
  • Fee-for-service
  • Service service service
  • Hospitals analyse and manage contracts
  • Capped contracts

11
DRG-s in Estonia
  • Implemented in 2004
  • There were a few articles about what DRGs are
    (Habicht)
  • Some presentations
  • Somehow infiltrated
  • Starting from 10/90 to 70/30 today

12
The BILL
  • Fee-for-service
  • Service service service
  • Hospitals analyse and manage contracts
  • Capped contracts
  • Bill services 30
  • DRG price 70

13
Conclusion?
  • Confusion
  • Loss of transparency

14
Hospital study
  • 2 hospitals regularly analyze the impact of DRGs
  • 1 hospital uses special program Datawell Visual
    DRG Pro
  • 7 years after implementation basic calculation
    principles still need to be introduced
  • EHIF finances over 90 of the hospital budget
  • Pärnu Hospital 10,2 M (45)
  • 70 7,1M

15
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17
Correcting
  • Is labour with suturation still labour or is it a
    complication?
  • Is a chronically ill heart failure patient a
    heart failure patient or a patient with heart
    rhytm problems?
  • Is stenocardia the main problem or is morbus
    ischaemicus cordis?

18
Classification
  • Official guidelines
  • Gynecology and obstetrics 2005
  • Hematology 2006
  • ICD-10
  • Doctors education
  • Most resourceful diagnose
  • Better statistics if dealth with

19
Case study - Pärnu Hospital
  • Around 15 000 bills that concern DRG
  • 2 300 dont classify
  • Over 50 of bills are covered by 22 DRGs

20
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21
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22
Are prices fair?
2005 2006 101
2006 2007 101
2007 2008 119
2008 2009 101
2009 - 2010 101
23
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24
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25
DRG 182
  • 2006-2010 DRG billing in infectious diseases
    department always negative
  • DRG 182 one of the most usual (1-3)
  • 01.01.2010 21.05.2010 42 cases
  • - negative financial aspect 44 710 EEK
  • - negative 19
  • - positive 23
  • Negative in cases with over 5 days admission

26
DRG 225
  • 2006-2010 DRG billing in orthopedics department
    always negative
  • DRG 225 one of the most usual (4-5)
  • 01.01.2010 21.05.2010 16cases
  • - negative financial aspect 29 269 EEK
  • - negative 13
  • - positive 3
  • Negative in higher class operations

27
Conclusion
  • DRGs are part of hospital financing system
  • Hospitals dont have resources or will or
    know-how or a reason to analyze
  • Made the system less transparent
  • There is so much information that could be used
    and we are moving towards that

28
  • Tervist!
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