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The Use of Diagnosis-Related Group-Based Reimbursement in the Czech Hospital Care System

Author

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  • Zuzana Kotherová

    (Department of Public and Social Policy, Institute of Sociological Studies, Faculty of Social Sciences, Charles University, Pekařská 16, 158 00 Praha 5, Czech Republic)

  • Martina Caithamlová

    (Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, nám. Sítná 3105, 272 01 Kladno 2, Czech Republic)

  • Juraj Nemec

    (Faculty of Economics and Administration, Masaryk University, Lipová 41a, 602 00 Brno, Czech Republic
    Faculty of Economics, Matej Bel University, Tajovského 10, 97401 Banská Bystrica, Slovakia)

  • Kateřina Dolejšová

    (Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, nám. Sítná 3105, 272 01 Kladno 2, Czech Republic)

Abstract

(1) Background: Diagnosis-Related Groups (DRG), one possibility of a hospital payment system, are currently used in most European countries. Introduced to the Czech system in the 1990s, the DRGs are currently used mainly for care reporting and partly for reimbursement. According to most experts, the use of DRG remain controversial. The goal of this paper was to study the effects of the current Czech DRG system on hospitals financing and, on this basis, to propose possible changes to the reimbursement mechanism in the Czech Republic. (2) Methods: Qualitative research methods were used for evaluating DRG mechanisms of application in three selected healthcare establishments in the CR in the period of 2012–2018. (3) Results: Our study shows that the current implementation of the DRG system is set up in a way that is very similar to traditional flat rates and is unlikely to yield major positive effects of the DRG mechanism, such as predictability of payments for hospitalisation cases, care quality and efficiency and transparent financing. (4) Conclusions: Based on our results, deep systemic change of the reimbursement mechanism in the Czech Republic is necessary. We propose five partial measures leading to the cultivation of the Czech DRG.

Suggested Citation

  • Zuzana Kotherová & Martina Caithamlová & Juraj Nemec & Kateřina Dolejšová, 2021. "The Use of Diagnosis-Related Group-Based Reimbursement in the Czech Hospital Care System," IJERPH, MDPI, vol. 18(10), pages 1-18, May.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:10:p:5463-:d:558356
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    References listed on IDEAS

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    1. Anne Mason & Zeynep Or & Thomas Renaud & Andrew Street & Josselin Thuilliez & Padraic Ward & ON BEHALF OF THE EURODRG GROUP, 2012. "How Well Do Diagnosis‐Related Groups For Appendectomy Explain Variations In Resource Use? An Analysis Of Patient‐Level Data From 10 European Countries," Health Economics, John Wiley & Sons, Ltd., vol. 21(S2), pages 30-40, August.
    2. Katja Grašič & Anne Mason & Andrew Street, 2015. "Paying for the quantity and quality of hospital care: the foundations and evolution of payment policy in England," Health Economics Review, Springer, vol. 5(1), pages 1-10, December.
    3. Robert B. Fetter, 1991. "Diagnosis Related Groups: Understanding Hospital Performance," Interfaces, INFORMS, vol. 21(1), pages 6-26, February.
    4. Or., Zeynep, 2014. "Implementation of DRG Payment in France: Issues and recent developments," Health Policy, Elsevier, vol. 117(2), pages 146-150.
    5. Simon, Michael, 2020. "Das DRG-Fallpauschalensystem für Krankenhäuser: Kritische Bestandsaufnahme und Eckpunkte für eine Reform der Krankenhausfinanzierung jenseits des DRG-Systems," Working Paper Forschungsförderung 196, Hans-Böckler-Stiftung, Düsseldorf.
    6. Anne Mason & Zeynep Or & Thomas Renaud & Andrew Street & Josselin Thuilliez & Padraic Ward & ON BEHALF OF THE EURODRG GROUP, 2012. "How Well Do Diagnosis‐Related Groups For Appendectomy Explain Variations In Resource Use? An Analysis Of Patient‐Level Data From 10 European Countries," Health Economics, John Wiley & Sons, Ltd., vol. 21(S2), pages 30-40, August.
    7. Alexander Geissler & David Scheller‐Kreinsen & Wilm Quentin & on behalf of the EuroDRG group, 2012. "Do Diagnosis‐Related Groups Appropriately Explain Variations In Costs And Length Of Stay Of Hip Replacement? A Comparative Assessment Of Drg Systems Across 10 European Countries," Health Economics, John Wiley & Sons, Ltd., vol. 21(S2), pages 103-115, August.
    8. Reinhard Busse & Alexander Geissler & Anne Mason & Zeynep Or & David Scheller‐Kreinsen & Andrew Street & Alexander Geissler & David Scheller‐Kreinsen & Wilm Quentin, 2012. "Do Diagnosis‐Related Groups Appropriately Explain Variations In Costs And Length Of Stay Of Hip Replacement? A Comparative Assessment Of Drg Systems Across 10 European Countries," Health Economics, John Wiley & Sons, Ltd., vol. 21, pages 103-115, August.
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