Stausberg Jürgen, Kiefer Emanuel
Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität München, Munich, Germany.
Health Serv Manage Res. 2010 Nov;23(4):154-9. doi: 10.1258/hsmr.2010.010002.
This study analysed the outstanding homogeneity of the German Diagnosis-Related Groups (G-DRG) using the reduction in variance (R²) of costs. Arbitrary increase in case groups, definition of additional charges and combination of several case groups in one DRG were considered as potential confounders. In 2009, the G-DRG-system offers an outstanding homogeneity with R² of 83.5% in comparison to 2004 with R² of 70.2%. The effect of an arbitrary increase in case groups is negligible. However, a simulation of the other confounders explains three-fourth of the increase in R² between 2004 and 2009. The definition of additional charges attributes in particular to the outstanding homogeneity. The assessment of DRG-systems with R² should be complemented with measures that are independent from a trimming of costs, e.g. relating actual costs with prospective payment. The G-DRGs left medical ground in order to achieve optimal economical homogeneity.
本研究利用成本方差缩减率（R²）分析了德国诊断相关分组（G-DRG）的显著同质性。病例组的任意增加、附加费用的定义以及将多个病例组合并为一个DRG被视为潜在的混杂因素。2009年，G-DRG系统具有出色的同质性，R²为83.5%，而2004年R²为70.2%。病例组任意增加的影响可忽略不计。然而，对其他混杂因素的模拟解释了2004年至2009年间R²增加的四分之三。附加费用的定义尤其有助于实现出色的同质性。用与成本削减无关的措施（如将实际成本与预期支付相关联）来补充对具有R²的DRG系统的评估。G-DRG为实现最佳经济同质性而偏离了医学依据。
