Case-based Payment Systems for Hospital Funding in Asia [electronic resource]: An Investigation of Current Status and Future Directions

2015·3.4 MB·English

by  Organisation for Economic Co-operation and Development

ComparativeCountryStudies
Volume1,Number22015
Case-based payment systems
for hospital funding in Asia:
an investigation of current
status and future directions
PeterLeslieAnnearandDaleHuntington,Editors
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ComparativeCountryStudies
Volume1,Number22015
Case-based payment systems
for hospital funding in Asia:
an investigation of current
status and future directions
PeterLeslieAnnearandDaleHuntington,Editors
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OECD
AsiaPacificObservatory »
onHealthSystemsandPolicies
Copyrightedi
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WHOLibraryCataloguing-in-PublicationData
Case-basedpaymentsystemsforhospitalfundinginAsia:aninvestigationofcurrentstatusandfuture
directions
(ComparativeCountryStudies,Vol.1No.22015)
III..EOcrognaonmiizcast,ioHnosfpoirtEalcso.no2.mHiocsCpiotoaplercaosttiso.nIa.nAdsiDaePvaeclifoipcmOebnste.rvIaIIt.oWroyrolndHHeeaalltthhSOyrsgtaenmiszaatnidonPoRleigciieosn.al
OfficefortheWesternPacific.
ISBN9789290617327 (NLMClassification:WX157JA1
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Contents
Introduction 2
PeterLeslieAnnear,DaleHuntington
Chapter1.ContextualissuesforDRG-basedhospitalpayment 10
PeterLeslieAnnear,KeXu
Chapter2:Issuesinthedesignandimplementationofcase-basedpayment 26
StephenDuckett
Chapter3:ImplementationexperiencewithDRG-basedpayments 54
SoonmanKwonandChangwooShon
Chapter4.Assessingtheimpactofcase-basedpayment 82
YukiMurakamiandJ.ucaI.orenzoni
Chapter5:Conclusionsandlessonsfortheregion 106
JohnC.Langenbrunner
Appendix1.Glossaryofmainterms 125
AuthorBiographies 128
1
Copyrightedma
Introduction
PeterLeslieAnnear,DaleHuntington
Introduction
Anumberofmiddle-incomecountriesintheAsiaandPacificregionare
introducingorconsideringtheimplementationofDiagnosis-Related
Groups(DRGs)asamethodformanaginghospitalfundingarrangements.
DRGscomewithinabroadercategoryofcase-basedoractivity-based
funding(ABF)arrangementsthatareusedprincipallyasamethodfor
increasingtheefficiencyofhospitalservices.DRG-basedhospitalpayment
systemsadoptastandardpricingframeworkthatprovidesequalityin
paymentsacrosshealth-careprovidersforservicesofthesamekind.
Generally,DRGsareintroducedtoaddresstheshortcomingsofpre-existing
fee-for-service(FFS)methodsofhospitalpayment,whichencouragean
oversupplyofservicestoincreaserevenue,and(inafewcases)fixed
capitationpaymentsystems,whichhavetheperverseeffectofreducing
supplyinordertoreducecostsbelowthecapitationlevel.DRGs,therefore,
provideatechnicalmeansforthemanagementandfinancingofpublic
and/orprivatehospitalservices,andareoftenlinkedwithsocialhealth
insuranceandgovernmentfundingmechanisms.
DRG-basedhospitalpaymentsystems
FirstdevelopedintheUnitedStatesofAmerica(USA),DRGshave
increasinglybeenusedforhospitalfundinginhigher-incomecountries.
ThepreciseuseofDRGs,however,variesbetweencountries,anddifferent
formsofABForcase-basedfundinghavebeendeveloped(seeAppendix
1foralistofdefinitions).Whiletheterminologyvaries,thebasicconcepts
remainconsistent.Inthisvolume,wethereforerefertocase-basedpayment
orDRG-basedpaymentsystemsasthetermforsuchhospitalfunding
arrangements.
DRG-basedpaymentsystemsgenerallyaimtoincreaseefficiencyinthe
provisionofhospitalservices.IntheAsiaandPacificregion,however,
DRG-andcase-basedpaymentmethodsareusedasameanstoachieve
betterplanningandresourceallocationinordertomeetpopulation
demandsforimprovedaccesstohospitalcare;toprovideincentivesfor
moreefficientservicedelivery;andtoimprovehealthserviceoutcomes.
Pre-existingformsofhospitalfundingaremostcommonlybasedonFFS
methodsor,inthecaseofgovernmenthospitals,line-itembudgeting.FFS
methodsareoftenopen-ended,provideanincentiveforover-servicing,
andmakecostcontrolmorechallenging.Line-itembudgetingisoften
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arbitrary,basedonpastpractice,andunrelatedtotheactualcostofservices
-budgetsthatarebelowtheactualcostofprovisioncauseanundersupply
ofservices,andbudgetsthatexceedcostsarefinanciallywasteful.Payment
systemsbasedonDRGsareafinancialandadministrativetooldesignedto
addressthesechallenges.OneexampleistheimplementationofDRG-based
hospitalpaymentsinThailand,whichaimedtoaddresslowadmission
ratesintheSocialSecuritySchemeandstrengthenpublicexpenditurefor
hospitalinpatientservices.
DRGsarethereforeamechanismforallocatingfundstohospitals
forservicesprovided,calculatedonthebasisofauniformlevelof
reimbursementforthecostsofcare,andaccordingtoasystemof
classificationofhospitalcases.TheDRGapproachprovidesbotha
financingmechanismandatooltomeasurehospitalactivity,thusit
involveselementsofbothfundingandmanagement.Itisameansto
allocatethefundingneededfortheprovisionofhospitalservices,andmay
alsobeseenasaproviderpaymentmechanismwithinthebroaderhealth-
carefinancingsystem.
AsiaPacificObservatoryonHealthSystemsandPolicies
Thestudythatprovidedthebasisforthechaptersinthisbookwascarried
outin2014-2015byateamofresearchersworkingwiththeAsiaPacific
ObservatoryonHealthSystemsandPolicies(APO)andtheOrganization
forEconomicCooperationandDevelopment(OECD).
Thestudyteamcomprised:
PeterAnnear,NossalInstituteforGlobalHealth,Universityof
Melbourne,Australia
StephenDuckett,TheGrattanInstitute,UniversityofMelbourne,
Australia
DaleHuntington,AsiaPacificObservatoryonHealthSystemsand
Policies,Manila
SoonmanKwon,SeoulNationalUniversity
JackLangenbrunner,AustralianDepartmentofForeignAffairsand
Trade,Jakarta
LucaLorenzoni,OECD,Paris
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Introduction
YukiMurakami,OECD,Paris
SupasitPannarunothai,NaresuanUniversity,Bangkok
VirojTangcharoensathien,InternationalHealthPolicyProgram,
Bangkok
KeXu,WorldHealthOrganizationRegionalOfficefortheWestern
Pacific,Manila
Thepanelofauthorsandresearchersdrewmainlyonpublishedand
greyliterature,aswellasexpertknowledgeoftheissues,tosurveythe
currentstatusofDRG-basedsystemsintheregion.Somemembersofthe
studyteamfirstmetinSeoulinNovember2013,andagainattheHealth
SystemsinAsiaconferenceinSingaporeinDecember2013,wheretheinitial
protocolforthestudywasprepared.AmeetinginBangkokinMarch2014
discussedthegeneraltechnicalcontentandmethodologyandinitialchapter
outlinesdeveloped.Theauthorssubsequentlypresentedthefirstdraftof
eachsubstantivechaptertoastudygroupmeetinginSeoulinAugust2014.
Thefinaldraftsofreviewedchaptersweresharedamongtheteamvia
teleconferencesinlate2014andearly2015.Allchapterswerepeer-reviewed
bythefollowing:IndraniGupta,NaotiIkegamiandRickMarshall.The
authorsaregratefulfortheircommentsandsuggestions.
Technicalandadministrativesupportwasprovidedforthestudybythe
APOSecretariat.TheOECDprovidedtechnicalsupportandaccesstothe
OECDdatabaseandresearchresources.
Purposeandscope
ThisvolumepresentsabackgroundstudyofDRG-basedpaymentsystems,
drawingontheexperienceofimplementingsuchhospitalfunding
arrangementsinternationally,includinganoverviewofdevelopmentsin
theAsiaandPacificregion.Theaimofthestudyistoprovideanevidence
baseandidentifylessonslearnedforemergingcountriesintheregionwho
areconsideringimplementingaDRG-basedpaymentsystem.Thepurpose
ofthestudyis:
• todescribethecontextinwhichDRGimplementationisbeing
considered;
• todescribethepolicyissuesrelatedtotheintroductionofDRG-
basedhospitalpaymentmethods;
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• todescribeissuesconfrontedinthedevelopmentand
implementationofDRG-basedpaymentsystems;
• toassesstheexperiencetodateacrosstheAsiaandPacific
region;and
• tolookatthelessonslearnedfromthewiderintroductionof
DRGmethodsinternationally.
ThisisthefirstvolumeonDRG-basedhospitalpaymentsystemsto
bepublishedbytheAPO.Itispublishedintheinterestofnational
governments,policy-makers,hospitalmanagers,theacademiccommunity,
anddevelopmentpartnerssupportingthestrengtheningofhealthsystems
intheAsiaandPacificregion.Volume1,presentedhere,outlinesthe
context,backgroundandbasicprinciplesthatunderlietheintroductionof
DRG-basedsystems;thegeneralexperienceintheregiontodate;andan
assessmentofeffectiveness.Asecondvolumeisplannedwhichwillinclude
anumberofcasestudiesonthepreparationforandimplementationof
DRG-basedsystemsinvariouslocationsacrosstheAsiaandPacificregion
usingacommonresearchprotocol.
ThisvolumefollowsanearlierpublicationbytheEuropeanObservatory
onHealthSystemsandPolicieseditedbyReinhardBusse,Alexander
Geissler,WilmQuentinandMiriamWiley.The2011study,Diagnosis-
RelatedGroupsinEurope:movingtowardstransparency,efficiencyandquality
inhospitals,providesthetheoreticalfoundationforthecurrentvolume
W(BHusOsebeytaIln.,ke20M1a1)t.haThuiesrvaonldumFreieadlrsiocbhuWiildtsteonnbeachsetru,dywhciarcrhiecdonosuitdtehrreodugh
theimplementationexperiencesandchallengesofDRG-basedpayment
systemsinlow-andmiddle-incomecountries(Mathaueretal.,2012;
Mathaueretal.,2013).
AcompanionvolumeintheAPOComparativeCountryStudiesseries
publishedin2015,PublichospitalgovernanceinAsiaandthePacific:Volume1,
Comparativecountrystudies,editedbyDaleHuntingtonandKrishnaHort,
reviewscasestudiesfromacrosstheAsiaandPacificregion(Huntington
etal.,2014).Boththecurrentvolumeandthehospitalgovernancestudy
areplacedwithinthecontextoftheregion'smovetowardsuniversal
coverageandincreasingpressureforgreaterefficiencyinserviceprovision.
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