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Systematically evaluating the impact of diagnosis-related groups (DRGs) on health care delivery: A matrix of ethical implications

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  • Fourie, Carina
  • Biller-Andorno, Nikola
  • Wild, Verina

Abstract

Swiss hospitals were required to implement a prospective payment system for reimbursement using a diagnosis-related groups (DRGs) classification system by the beginning of 2012. Reforms to a health care system should be assessed for their impact, including their impact on ethically relevant factors. Over a number of years and in a number of countries, questions have been raised in the literature about the ethical implications of the implementation of DRGs. However, despite this, researchers have not attempted to identify the major ethical issues associated with DRGs systematically. To address this gap in the literature, we have developed a matrix for identifying the ethical implications of the implementation of DRGs. It was developed using a literature review, and empirical studies on DRGs, as well as a review and analysis of existing ethics frameworks. The matrix consists of the ethically relevant parameters of health care systems on which DRGs are likely to have an impact; the ethical values underlying these parameters; and examples of specific research questions associated with DRGs to illustrate how the matrix can be applied. While the matrix has been developed in light of the Swiss health care reform, it could be used as a basis for identifying the ethical implications of DRG-based systems worldwide and for highlighting the ethical implications of other kinds of provider payment systems (PPS).

Suggested Citation

  • Fourie, Carina & Biller-Andorno, Nikola & Wild, Verina, 2014. "Systematically evaluating the impact of diagnosis-related groups (DRGs) on health care delivery: A matrix of ethical implications," Health Policy, Elsevier, vol. 115(2), pages 157-164.
    • Handle: RePEc:eee:hepoli:v:115:y:2014:i:2:p:157-164
    DOI: 10.1016/j.healthpol.2013.11.014
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    References listed on IDEAS

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    1. Reinhard Busse & Tom Stargardt & Jonas Schreyögg, 2005. "Determining the “Health Benefit Basket” of the Statutory Health Insurance scheme in Germany," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 6(1), pages 30-36, November.
    2. Kass, N.E., 2001. "An ethics framework for public health," American Journal of Public Health, American Public Health Association, vol. 91(11), pages 1776-1782.
    3. Reinhard Busse & Jonas Schreyögg & Peter Smith, 2006. "Editorial: Hospital case payment systems in Europe," Health Care Management Science, Springer, vol. 9(3), pages 211-213, August.
    4. John C. Langenbrunner & Cheryl Cashin & Sheila O’Dougherty, 2009. "Designing and Implementing Health Care Provider Payment Systems : How-To Manuals," World Bank Publications - Books, The World Bank Group, number 13806.
    5. Davis, Carolyne K. & Rhodes, Deborah J., 1988. "The impact of DRGs on the cost and quality of health care in the United States," Health Policy, Elsevier, vol. 9(2), pages 117-131, April.
    6. Pollitt, Christopher, 1987. "Capturing Quality?: The Quality Issue in British and American Health Policies," Journal of Public Policy, Cambridge University Press, vol. 7(1), pages 71-92, January.
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