Bystrov Victor, Staszewska-Bystrova Anna, Rutkowski Daniel, Hermanowski Tomasz
Faculty of Economics and Sociology, University of Lodz, Rewolucji 1905 r. 41, 90-214 Lodz, Poland.
National Health Fund, Poland.
Health Policy. 2015 Aug;119(8):1119-25. doi: 10.1016/j.healthpol.2015.04.017. Epub 2015 May 8.
A prospective payment system based on Diagnosis Related Groups (DRGs) presents strong financial incentives to healthcare providers. These incentives may have intended as well as unintended consequences for the healthcare system. In this paper we use administrative data on stroke admissions to Polish hospitals in order to demonstrate the response of hospitals to the incentives embedded in the design of stroke-related groups in Poland. The design was intended to motivate hospitals for the development of specialized stroke units by paying significantly higher tariffs for treatment of patients in these units. As a result, an extensive network of stroke units has emerged. However, as it is shown in the paper, there is no evidence that outcomes in hospitals with stroke units are significantly different from outcomes in hospitals without stroke units. It is also demonstrated that the reliance on the length of stay as a major grouping variable provides incentives for regrouping patients into more expensive groups by extending their length of stay in stroke units. The results of the study are limited by the incompleteness of the casemix data. There is a need to develop information and audit systems which would further inform a revision of the DRG system aimed to reduce the risk of regrouping and up-coding.
基于诊断相关分组（DRGs）的前瞻性支付系统给医疗服务提供者带来了强大的经济激励。这些激励措施可能会对医疗系统产生预期和非预期的后果。在本文中，我们使用波兰医院中风入院的管理数据，以证明医院对波兰中风相关分组设计中所蕴含激励措施的反应。该设计旨在通过为这些科室的患者治疗支付显著更高的费用，激励医院发展专门的中风科室。结果，一个广泛的中风科室网络出现了。然而，正如本文所示，没有证据表明设有中风科室的医院的治疗结果与没有中风科室的医院有显著差异。研究还表明，将住院时间作为主要分组变量会促使医院通过延长中风科室患者的住院时间，将患者重新分组到更昂贵的组中。该研究结果受到病例组合数据不完整的限制。有必要开发信息和审计系统，以便为修订DRG系统提供更多信息，旨在降低重新分组和高编的风险。
