สถานะทางการเงินและคุณภาพการบริการของโรงพยาบาลภายใต้กลไกการจ่ายเงินแบบกลุ่มวินิจฉัยโรคร่วม Hospital Financial Status and Quality of Care under Diagnosis Related Groups Payment Mechanism

Abstract

Objective: To assess impact of diagnosis related groups (Diagnosis relatedgroups, DRGs) on hospital financial performance, to identify diseases whichcause negative financial status, to evaluate appropriateness of inpatientresource consumption and to assess quality outcomes. Methods: Thisstudy was retrospective study. We used data of all in-patients eligible forthe universal coverage (UC) scheme in fiscal year 2010 of NopparatRajathani hospital. Financial performance was defined as differencebetween hospital cost and the reimbursement received from the NationalHealth Security Office (NHSO). Appropriateness of resource consumptionwas determined as proportions of resource used among top ten mostnegative financial performance medical conditions. Internal medicinedepartment (IMD) head was asked to review appropriateness of resourceutilization. Quality of care was measured by two concepts; readmission ratewithin 30 days and pre-mature discharge. Results: There were 11,404admissions during 2010 fiscal year. Cost of care for these patients was202.62 million baht; however, the hospital was reimbursed at 103.70 millionbaht, resulting in 98.92 million baht lost per year. Pneumonia (J189),Urinary tract infection (N390), COPD with exacerbation (J441) were top 3medical conditions that caused highest lost. Medical materials andequipments (such as electrocardiogram and respirator), with their costs tobe the highest proportion, were however confirmed necessary by the IMDhead. Use of expensive originator drugs were found among top ten DRGswhich caused financial lost. If half of that were replaced by generic drug, itwould have saved the hospital 1.16 million baht. Hospital readmission ratewas found to be 5.3%. This rate was lower than other studies, whichreadmission rate ranged from 5 - 17%. Premature discharge was reportedby 27.8%; however, 85.8% of these discharges were labeled “improved.”Conclusion: DRGs payment method caused negative financial status forthe studied hospital. Resource utilization was appropriate. Re-admissionrate and pre-mature discharge was low. Further studies should focus onhigh financial lost DRGs and the hospital own unit cost data.Keywords: diagnosis related groups, financial status, quality of care,universal coverage scheme