Department of Economics, University of Malta, Malta.
Department of Economics, City, University of London, United Kingdom.
Health Policy. 2018 Nov;122(11):1183-1189. doi: 10.1016/j.healthpol.2018.08.002. Epub 2018 Aug 22.
The healthcare system in Malta is financed through global budgets and healthcare is provided free at the point of use. This paper is a first attempt to examine the feasibility of introducing a Diagnosis Related Groups casemix system for Malta, not necessarily for payment and funding purposes, but as a tool to help describe, manage and measure resource use. This is particularly challenging in view of the constraints and characteristics of a small state country. The study evaluates the applicability of the MS-DRG (Version 27.0) Grouper to describe acute hospital activity on the island. The classification of 151,615 admissions between 2009-2011 resulted in 636 DRG categories. Around half of these DRGs accounted for 99% of the total activity at the hospital, while 296 DRG categories had fewer than 15 cases over the period. Patient length of stay is used to explain resource use and the Coefficient of Multiple Determination obtained was of 0.19 (improving to 0.25 when a number of trimming algorithms were applied). A good proportion of the resulting DRGs had a Coefficient of Variation, which indicates a low degree of variability within the obtained DRG groups. This presents good evidence to support the introduction of a DRG system in Malta particularly in view of the recent drive towards more public-private partnerships and legislation on cross-border patient treatment.
马耳他的医疗体系通过全球预算提供资金，医疗服务在使用时免费。本文首次尝试探讨在马耳他引入按诊断相关分组（DRG）病例组合系统的可行性，不一定是为了支付和资金目的，而是作为一种帮助描述、管理和衡量资源使用的工具。考虑到小国的限制和特点，这是一项具有挑战性的工作。本研究评估了 MS-DRG（第 27.0 版）分组器在描述该岛急性医院活动方面的适用性。对 2009 年至 2011 年间 151615 例住院患者的分类，共产生 636 个 DRG 类别。这些 DRG 中有一半左右占医院总活动的 99%，而在这期间，有 296 个 DRG 类别每个类别的病例少于 15 例。患者住院时间用于解释资源使用情况，获得的多重决定系数为 0.19（当应用一些修剪算法时，提高到 0.25）。很大一部分产生的 DRG 具有变异系数，这表明在获得的 DRG 组内变异程度较低。这为在马耳他引入 DRG 系统提供了很好的证据支持，特别是考虑到最近对公私合作伙伴关系的推动以及跨境患者治疗的立法。
