engleski

The effects of diagnosis-related groups payment on efficiency of the hospital health care in Croatia

In the mid-1990s, European countries took action to reform their health provider payment systems to better control health expenditures and improve the performance of their health sectors (1). This occurred at a time when Croatia was going through a period of transition and was struggling to meet the financial needs of hospitals, which threatened the financial sustainability of the health sector as a whole (2). In order to address this growing problem, Croatia embarked on hospital financing reforms. It followed international practice of replacing its historic budget hospital funding model with an output-based system. The reform began in 2002, when hospital activity payment criteria were introduced in the form of classifications called payment per therapeutic procedure (PPTP). The PPTP system comprised 116 broad payment groups representing high-volume inpatient cases, which accounted for a large proportion of hospitals’ inpatient expenditure. While well intended, the system proved ineffective due to flaws in both its pricing and the structure of the payment mechanism (3). In 2007, Croatia procured a license for the Australian Refined Diagnosis Related Groups (AR- DRG) which like all DRGs, is primarily an inpatient classification system that groups patients into clinically meaningful and resourceuse homogeneous groups. As DRGs measure the level of hospital inpatient activity, it is possible to gauge hospitals’ relative efficiency by relating each hospital’s resource use to its output as measured by DRG activity (4, 5). The country embarked on DRG implementation with the following key stakeholders: the Ministry of Health (MOH), which has the stewardship role over the health system and is also the operator of the nation’s tertiary referral hospitals ; the Croatian Health Insurance Fund (CHIF), a statutory agency responsible for the national mandatory and supplementary health insurance systems and the central national purchaser of health care services ; and county governments and the City of Zagreb, which operates hospitals in their own regions. The aim of this study was to assess the effectiveness of the reform in the funding of inpatient care that has involved the implementation of the DRG system.

diagnosis-related groups payment ; efficiency of the hospital health care ; Croatia

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