Mikkola Hennamari, Keskimäki Ilmo, Häkkinen Unto
STAKES, National Research and Development Centre for Welfare and Health, PO Box 220, FIN-00531 Helsinki, Finland.
Health Policy. 2002 Jan;59(1):37-51. doi: 10.1016/s0168-8510(01)00169-5.
In the early 1990s, DRG based hospital financing was introduced into some hospital districts in Finland. The 1993 state subsidy reform decentralising all hospital financing to municipalities, and the aim of improving productivity, were the driving forces for introducing DRG. This study addresses the pros and cons of DRG in hospital financing in the Finnish health care system and puts forward several solutions to avoid potential problems. We consider the objectives and optimal features of hospital financing systems in the context of the public health care system, where the public sector owns and finances hospitals. We analyse impacts of introducing different types of DRG based hospital financing systems, taking into account earlier experiences in countries such as Sweden and Norway, as well as Finnish system specific features. DRG could assist the Finnish municipalities to compare quality, costs and prices of services between hospitals, and related cost information might help them budget expenditure more accurately. System specific features mean that traditional uses of DRG in hospital pricing are not feasible in Finland. But some benefits of DRG could be exploited, for instance in the controlled contracts between municipalities and hospitals.
20世纪90年代初，基于诊断相关分组（DRG）的医院融资模式被引入芬兰的一些医院区。1993年的国家补贴改革将所有医院融资下放到各市镇，提高生产率的目标是引入DRG的驱动力。本研究探讨了DRG在芬兰医疗保健系统医院融资中的利弊，并提出了几种避免潜在问题的解决方案。我们在公共部门拥有并为医院提供资金的公共医疗保健系统背景下，考虑医院融资系统的目标和最佳特征。我们分析了引入不同类型基于DRG的医院融资系统的影响，同时考虑了瑞典和挪威等国的早期经验以及芬兰系统的具体特征。DRG可以帮助芬兰各市镇比较不同医院的服务质量、成本和价格，相关成本信息可能有助于它们更准确地编制预算支出。系统的具体特征意味着DRG在医院定价中的传统用途在芬兰不可行。但可以利用DRG的一些好处，例如在各市镇与医院之间的控制合同中。
