Transcript Prezentare Dana Burduja la conferinta PCU

Case Mix in Romania:
From Project(s) to
National Scale
Implementation
Dana Burduja, JSI
Romanian DRG Project Coordinator
[email protected]
Bucharest, November 2002
www.drg.ro
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ROMANIA:
22,500,000 inhabitants
42 counties
Capital – Bucharest, 2,500,000 inhabitants
Social Health Insurance System (1997)
4.2% of GDP for health (2002) – 70 USD per capita
Main health system actors:
Ministry of Health and Family – policy
National Health Insurance House – financing
College of Physicians – quality of care
Providers – primary care, ambulatory, HOSPITALS, others
www.drg.ro
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Problems/Solutions
• Underfinanced system
• Non objective allocation to the • Increased % of GDP for
health – POLITICAL
big consumers – HOSPITALS
decision !!!
(70%)
• Non efficient spending, waste
at hospitals level
• No evidence of hospitals
outputs
• CASE BASED FINANCING
SYSTEM FOR HOSPITALS
(technical and political
decision)
• Acceptable quality of care
www.drg.ro
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Practical Solution:
Case Based Financing System
OBJECTIVES:
OBJECTIVES:
General
Specific
• Transparency in allocation of
limited resources
Transfer of technical tools to local
and national institutions
• Reduce inefficiency and waste at
hospital consumption level
• In country capacity for
institutional buy-in and
ownership
• Data for health policies and hospital
management
• Quality of services maintained or
increased at hospital level
www.drg.ro
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History of DRGs in Romania
• 1995 – 1997: pilot 3M/NCHS (project)
• 1997 – 1999: pilot 3M/NCHS (enlarged project)
• 1999 – 2001: pilot DHHS/IHSM, complete piloting of the
DRG system for University Hospital Cluj
• 2000 – present: roll out DHHS/JSI/Romania
National DRG Project
All USAID funded
www.drg.ro
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DRG National Project
INSTITUTIONS:
TEAMS:
• National Health Insurance House
• Project Management
• Coding
• Management Information
Systems
• Costing
• Communication
• Legislation/Policy/Regulation
• Quality
• Education
• 23 Hospitals (I, U, C, M)
• Ministry of Health and Family
National Center for Health Statistics
Institute for Health Services Management
• College of Physicians
• Ministry of Finance
• 23 Hospitals (all types)
• USAID Romania
• DHHS, JSI, USA
www.drg.ro
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2001, 23 Project Hospitals
• ICD 10 for dx, ICPM Ro version for procedures
• MBDS, clinical patient level data collection
• Training
• Grouping
• Data analysis
• Training
• Department level cost data collection
• Modeling the reimbursement scheme
• Training
• Preliminary national scale implementation plan
www.drg.ro
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2002, Project & Implementation
• Actual case based reimbursement for project 23 hospitals
(contracting, coding, data collection, grouping, financing
etc)
• ICD 10 coding training national level
• Implementation Strategy Team operational
• Data analysis operational (quality indicators)
• Implementation strategy legislated and started to be
implemented
www.drg.ro
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2002, Implementation
• Contracting and financing of 23 hospitals
• Implementation Strategy – team and plan – operational
• ICD 10 coding training national level
• Clinical data collection prepared for the national level
(software, medical record)
• Cost data collection started national level
• Data analysis ongoing (clinical and cost data)
• Establishment of a Central Institution responsible for
technical implementation
www.drg.ro
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www.drg.ro
CMI
ALoS
10
2002 07
2002 06
2002 05
2002 04
2002 03
2002 02
2002 01
2001 12
2001 11
2001 10
2001 09
2001 08
2001 07
2001 06
2001 05
2001 04
2001 03
2001 02
2001 01
CMI
CMI and ALOS
January 1, 2001 – July 31, 2002
days
0,8
9
0,7
8
0,6
7
0,5
6
5
0,4
4
0,3
3
0,2
2
0,1
1
0
0
year/month
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Alte interv chirurg asupra sist.
musc-scheletal si a tes conj fara
CC
2,5%
Boli ale fic cu exc tumorilor,
cirozei, hepatitei alcool fără CC
Avortul cu dilatare şi chiuretaj,
chiuretaj prin aspir. sau hist.
Insuficienţa cardiacă şi şocul
Probleme medicale ale spatelui
Nou-născutul normal
Otită medie şi inf resp.sup. vârsta
0-17 ani
www.drg.ro
Naşterea vaginală fără dg
complicat
Hipertensiunea arterială
Top 10 Romanian DRGs
compared with Hungarian data
3,0%
% cases Hungary
% cases Romania
2,0%
1,5%
1,0%
0,5%
0,0%
www.drg.ro
Boli ale ficatului cu exc tumorilor,
cirozei, hepatitei alcool fara CC
Avortul cu dilatare si chiuretaj,
chiuretaj prin aspiratie sau
histerectomie
Insuficienta cardiaca si socul
Probleme medicale ale spatelui
Nou-nascutul normal
12
Alte interv chirurg asupra sist.
musc-scheletal si a tes conj fara
CC
10
Otita medie si inf resp. sup. varsta
0-17 ani
12
Nasterea vaginala fara dg
complicat
Hipertensiunea arteriala
ALOS for Romanian top 10 DRGs
compared with Hungarian data
14
ALoS Hungary
ALoS Romania
8
6
4
2
0
2003 and Beyond
• Financing 23+ hospitals
• Ongoing implementation strategy refined
• Data collection ALL hospitals
• Data analysis ongoing
• Refined reimbursement scheme
• Central Institution running the implementation
www.drg.ro
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Challenges
• Limited funds central and local level
• Poor dialogue at political and technical level,
central and/with local
• Competing and often conflicting incentives
within the health care system
• Poor history of team work, defined and
assumed ownership and leadership
www.drg.ro
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Factors of Success
• Technical tool to address several goals and
objectives
• Built in country technical expertise
• 2 levels of support – technical to induce political,
and political to support technical
• Action – real piloting of the implementation
• Build and transfer the leadership and the
ownership
www.drg.ro
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Achievements & Lessons Learned
• Political support, leadership and ownership
assumed both at central level and local level
• Development of a core of local experts/technical
assistance and piloting of the case based
financing tools
• National scale implementation planned and
agreed for all Romanian acute care hospitals by
the end of 2004.
www.drg.ro
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THANK YOU FOR YOUR ATTENTION,
GREETINGS FROM ROMANIA!
www.drg.ro
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