OBJECTIVE This paper provides a comprehensive overview of hospital payment systems based on diagnosis-related groups (DRGs) in low- and middle-income countries. It also explores design and implementation issues and the related challenges countries face. METHODS A literature research for papers on DRG-based payment systems in low- and middle-income countries was conducted in English, French an...

Introduction A principal reason for investing in case mix as a tool for hospital administration is that it allows the value of production embodied in an episode of care to be different from the cost of that episode. Useful case-mix evaluation retains a statistical nexus between value and cost of production. The value placed on a hospital system’s output should fit with the aggregate cost of the...

This paper examines the quality of routinely collected information in an Iranian hospital in a trial of casemix classification. Australian Refined Diagnosis Related Groups (AR-DRG) were used to classify patient episodes. There were 327 DRGs identified, of which 20% had only 1 case. The grouper program identified invalid records for 4% of total separations. Approximately 4.5% of cases were class...

This study was conducted to evaluate the ability of AN-DRG version 3.1 to predict variation in patients' length of stay in hospital (LOS) and identify other factors that can influence the LOS by using routinely collected hospital morbidity data. A total of 18 DRGs that comprised 4,589 episodes were analysed. Multiple regression was used to model length of stay as a function of a number of indep...

The objective of the project was to evaluate a pilot Post Acute Community Care (PACC) program for orthopaedic patients. A series of cross-sectional surveys elicited responses of patient and home carer needs and GP and hospital staff acceptability while a cost-minimisation analysis compared the average cost of the PACC program with general orthopaedic hospital care. Patients were classified acco...

leaves only the biomaterial and hollow channels; SEM of gelatin with extracted PCL (magnification 1.50 KX, scale bar 20 μm) (c); Confocal fluorescent image of a DRG stained with phalloidin rhodamine (actin) after 4 days on the scaffold consisting of gelatin, elastin, and hollow channels (magnificiation 10X, scale bar 200 μm (d); Average aspect ratio of the DRGs on various fibrous scaffolds afte...

BACKGROUND Given limited health sources, how to make DRGs (Diagnosis Related Groups) more feasible is a big question in developing countries. This study contributes to the debate on how to bridge the pay-for-service and DRGs during the transitional period of payment reform. METHODS From 2008 to 2012, 20740 patients with cirrhosis or duodenal ulcer disease were chosen as sample. Using multiple...

Forensic practice fees, billing, and collection procedures are quite different from those in general psychiatry. Most forensic practices have far fewer "clients," and individual bills are usually larger. Collections are usually better (and less frequently discounted) in forensic practice, and resolving billing disputes is far more straightforward. Medicare, Medicaid, other insurance coverage, p...

This paper develops a model in which physicians choose the level of services to be provided to their patients. We show that if physicians undervalue benefits to patients relative to hospital profits, prospective payment, a system in which hospitals receive a payment dependent on the diagnosis-related group within which a patient falls, can lead to too few services being provided. In contrast, a...

INTRODUCTION AND OBJECTIVES Cardiac care is one of the most important and rapidly rising costs in the healthcare system. Therefore, any improvement can produce significant savings. We analyze the evolution of classical clinical effectiveness indexes in a cardiac unit after a change in clinical management. METHODS We reviewed overall clinical effectiveness indexes and the most significant DRGs...