Diagnosis-related groups – towards economic efficiency: operating revenues and costs analysis

Abstract :

On July 1, 2008, Narodowy Fundusz Zdrowia – NFZ (National Health Fund) introduced a new form of medical services contracting and financing – DRG-based payment  system.  The most  important  objectives  related  to  the  implementation of this payment system included an improvement in the economic efficiency and quality of medical services. The NFZ carried out the valuation of Diagnosis-related groups (point system) whose tariffs are equal for all types of hospitals, regardless of the region where they run their activity. Revenues from sale of medical services generated under contracts signed with NFZ and refunded on the basis of DRG are the main source of revenue (from 65% to 90%) for each hospital. The aim of this article is first to calculate the costs of medical services and then to analyze and compare them within the same DRG taking as example the groups F72 (inguinal hernia) and F73 (abdominal hernia) in order to verify if funding from NFZ covers all necessary costs occurred during hospitalization of patients. In order to achieve this aim, the author used the documentary analysis methodology (the literature review,  the  analysis  of  medical  documents),  as  well  as  comparative  analysis.

Keywords :  DRG,  diagnosis-related  groups,  cost  calculation,  benchmarking, medical services, hospitals, Poland

JEL Classification : M41