Related Experiment Videos
[Diagnosis-related groups and neonatal surgical patients]
A B Mathisen1, S Vaaler, E Amlie
1Senter for epidemiologi og sykehusstatistikk, Rikshospitalet, Oslo.
Insights
The current Diagnosis Related Groups (DRG) system inadequately covers neonatal surgery costs. A new prospective method accurately measures patient costs, revealing significant financial shortfalls for this patient group.
Area of Science:
- Healthcare economics
- Surgical outcomes
- Neonatal medicine
Context:
- Diagnosis Related Groups (DRG) aim to improve hospital efficiency but have limitations.
- Existing coding systems inadequately represent costs in specialized areas like neonatal care.
- Accurate patient cost measurement is crucial for financial viability.
Purpose:
- To evaluate the adequacy of the DRG system for neonatal surgery.
- To introduce and test a prospective method for measuring individual patient costs.
- To analyze the financial impact of neonatal surgery on healthcare providers.
Summary:
- A prospective method categorizes hospital stays by treatment intensity (intensive, intermediate, ordinary care) and procedure costs.
- This method was applied to neonatal surgery for gastrointestinal and urinary tract conditions.
- Calculated costs (NOK 291,181) significantly exceeded DRG reimbursement (NOK 100,390), indicating a deficit of NOK 190,970.
Impact:
- Neonatal surgery patient groups appear to be underfunded by the current DRG system.
- The developed prospective method offers a reliable approach for verifying actual patient costs across diverse medical groups.
- This research highlights the need for DRG system refinement to ensure equitable reimbursement for complex pediatric surgical cases.
Abstract:
Diagnose Related Groups (DRG) are defined on the basis of the principal diagnosis, secondary diagnoses, procedures, age, sex and discharge status, and were developed to improve hospital productivity and efficacy. Existing code systems do not cover all medical specialties equally well; examples are neonatal medicine, cancer treatment and rehabilitation. We have developed a prospective method to measure actual costs related to patients individually. The major element in this method is based upon the hospital stay being divided into types of treatment with different resource requirements: heavy intensive care, light intensive care, intermediate care and ordinary care. In addition, costs related to surgery and other procedures are measured. Our method was used to calculate costs related to neonatal surgery due to various inborn diseases in the gastrointestinal tract and the urinary system. All patients needed immediate care and competent medical intervention. Mean costs for the group was NOK 291,181 while total reimbursement to the hospital was NOK 100,390, resulting in a net negative balance of NOK 190,970. Neonatal surgery does not seem to be adequately covered by the DRG system. This complex patient group provides a comprehensive test of the prospective method, and after evaluation we feel that it can be used in most other patient groups to verify actual cost.