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DRG implementation in Estonian health care model – hospital perspective

DRG implementation in Estonian health care model – hospital perspective. Teele Orgse 4th Nordic Casemix Conference June 4th 2010 Helsinki. The Republic of Estonia. Parliamentary republic, president elected for 5 years (Mr. Toomas Hendrik Ilves) Official language – Estonian

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DRG implementation in Estonian health care model – hospital perspective

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  1. DRG implementation in Estonian health care model – hospital perspective Teele Orgse 4th Nordic Casemix Conference June 4th 2010 Helsinki

  2. The Republic of Estonia • Parliamentary republic, president elected for 5 years (Mr. Toomas Hendrik Ilves) • Official language – Estonian • Coastline – 3794 km with 1521 islands • Total area – 45 227 km2 • Population – 1 370 000 (Estonians 65%, Russians 28%, Ukrainians 3%, Belorussians 1%, Finns 1%, other 2%) • Independent since 24.02.1918, occupied by the Soviet Union 1940, regained the independence on 20.08.1991. Member of the European Union since May 1st 2004. • We have been here since 6500 BC!

  3. Background – Soviet heritage • Centralized • state-controlled • over-capacitated provider network (120 hospitals with 18 000 beds) • Polyclinics • budget financed

  4. Background - reforms • Began in the end of 1980s • Economic collapse, high inflation and political clutter – the aim was: • to improve the efficiency and quality of health care system • to meet the needs of a small country and its population • Decentralization of primary and hospital care to local administrative level • Elimination of special systems • Separation of powers • January 1st 1992: Health Insurance Law • From tax-based to insurance-based • Hospital network reorganization • Health care providers – operating under private law

  5. Hospital Master Plan Regionalism Golden Circle

  6. Financing

  7. Contracting Need assessment 4-year financial prognosis Quarterly assessment Designing of budget Contracting The most cost-efficient system in Europe because of the contracting system. The supreme winner in the 2007 and 2008 BFB (bang-for-the-buck) scores (Euro Health Consumer Index 2008 report).

  8. Contract

  9. Health care services list • Calculated by the EHIF, consulted with specialists and hospitals • Over 130 pages • Lists every detailed service – coded + priced

  10. The BILL • Fee-for-service: • Service + service + service = € € € • Hospitals analyse and manage contracts • Capped contracts

  11. DRG-s in Estonia • Implemented in 2004 • There were a few articles about what DRGs are (Habicht) • Some presentations • “Somehow infiltrated” • Starting from 10%/90% to 70%/30% today

  12. The BILL • Fee-for-service: • Service + service + service = € € € • Hospitals analyse and manage contracts • Capped contracts • Bill = services 30% + DRG price 70%

  13. Conclusion? • Confusion • Loss of transparency

  14. Hospital “study” • 2 hospitals regularly analyze the impact of DRGs • 1 hospital uses special program – Datawell Visual DRG Pro • 7 years after implementation basic calculation principles still need to be introduced • EHIF finances over 90% of the hospital budget • Pärnu Hospital 10,2 M € (45%) • 70% 7,1M €

  15. Correcting • Is labour with suturation still labour or is it a complication? • Is a chronically ill heart failure patient a heart failure patient or a patient with heart rhytm problems? • Is stenocardia the main problem or is morbus ischaemicus cordis?

  16. Classification • Official guidelines: • Gynecology and obstetrics 2005 • Hematology 2006 • ICD-10 • Doctors education • “Most resourceful diagnose” • Better statistics if dealth with

  17. Case study - Pärnu Hospital • Around 15 000 bills that concern DRG • 2 300 don’t classify • Over 50% of bills are covered by 22 DRGs

  18. Are prices fair?

  19. DRG 182 • 2006-2010 DRG billing in infectious diseases department always negative • DRG 182 one of the most usual (1-3) • 01.01.2010– 21.05.2010 42 cases - negative financial aspect 44 710 EEK - negative 19 - positive 23 • Negative in cases with over 5 days admission

  20. DRG 225 • 2006-2010 DRG billing in orthopedics department always negative • DRG 225 one of the most usual (4-5) • 01.01.2010– 21.05.2010 16cases - negative financial aspect 29 269 EEK - negative 13 - positive 3 • Negative in higher class operations

  21. Conclusion • DRGs are part of hospital financing system • Hospitals don’t have resources or will or know-how or a reason to analyze • Made the system less transparent • There is so much information that could be used and we are moving towards that

  22. Tervist!

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