Financial access of pensioners to emergency onco-hematological services after the implementation of the DRG model
DOI:
https://doi.org/10.52340/healthecosoc.2023.07.02.06Keywords:
access to medical services, pensioners, onco-hematological services, diagnosis-related groups (DRG) financing modelAbstract
Introduction: the most important task of the healthcare system of any state is to increase financial access to medical services for the population. In 2022, a diagnosis-related groups (DRG) financing model for planned and emergency inpatient services was launched in Georgia, the main task of which is to improve access to medical services and the quality of services. Despite the implementation of the DRG model, hematological oncology patients, including those of retirement age, have to pay a certain fee for services that were previously provided free of charge. The aim of the paper is to assess the financial access of pensioners to urgent onco-hematological services after the introduction of the DRG method. Methodology: Quantitative and qualitative research methods were used. Results: The study showed that the majority of patients of retirement age (78%) had to pay 235 GEL after leaving the hospital. However, it should be taken into account that the majority of patients (64%) are not financially independent. Consequently, the majority of respondents (79%) faced financial difficulties due to payment for urgent oncology-hematological services. According to the majority of respondents (80%), after the introduction of the DRG model, the financial availability of the onco-hematological inpatient services they received decreased. Discussion, recommendations: after the introduction of the model of groups struggling with the diagnosis, the upper limit of co-payment for onco-hematological services is a rather large amount for people of retirement age, which reduces financial availability. It is advisable to review the co-payments imposed on these services.
References
ვერულავა, თ. (2023). ჯანდაცვის პოლიტიკა. კავკასიის უნივერსიტეტი.
ვერულავა, თ., ჯორბენაძე რ. (2020). ჯანდაცვაზე ხელმისაწვდომობა, როგორც ფუნდამენტური უფლება თუ პრივილეგია? ეკონომიკა და ბიზნესი, 12 (4).
ჯორბენაძე ა., ვერულავა, თ. (2021). დიაგნოზთან შეჭიდული ჯგუფებით (DRG) საავადმყოფოს დაფინანსების მეთოდი და 1995 წლის ჯანდაცვის რეფორმები. ეკონომისტი, XVII (4): 31-41
ჯანმრთელობის ეროვნული სააგენტო (2022). DRG სისტემის დანერგვა საქართველოში.https://nha.moh.gov.ge/ge/news/mosalodnelicvlilebebiDRGsisstemisdanergvastandakavshirebit. (13.06.2023).
ჯანმრთელობის ეროვნული სააგენტო (2022). დიაგნოზთან შეჭიდული ჯგუფების (DRG) მიხედვით დაფინანსების მექანიზმი. https://nha.moh.gov.ge/storage/files/shares/DRG/MOH%206%2022%2000000165%20danartiN1%20(1).pdf. (13.06.2023).
Busato, A., & von Below, G. (2010). The implementation of DRG-based hospital reimbursement in Switzerland: A population-based perspective. Health research policy and systems, 8(1), 1-6.
Busse, R., Schreyögg, J., Smith, P.C. (2006). Hospital case payment systems in Europe. Health Care Management Science, 9(3):211–13.
Cylus, J., & Irwin, R. (2010). The challenges of hospital payment systems. Euro Observer, 12(3), 1-3.
Fetter, R. B., Shin, Y., Freeman, J. L., Averill, R. F., & Thompson, J. D. (1980). Case mix definition by diagnosis-related groups. Medical care, 18(2), i-53.
Furstenberg T, Zich K, Nolting H, Laschat M, Klein S, Ha ̈ ussler B. G-DRG impact evaluation. Final report of the first research cycle (2004-2006). IGES Institut, Institut fu ̈r das Entgeldsystem in Krankenhaus. 2010.
Gulliford, M. C., Dregan, A., Moore, M. V., Ashworth, M., Van Staa, T., McCann, G., ... & McDermott, L. (2014). Continued high rates of antibiotic prescribing to adults with respiratory tract infection: survey of 568 UK general practices. BMJ open, 4(10), e006245.
Hervis, R. M. (1993). Impact of DRGs on the medical profession. Clinical Laboratory Science: Journal of the American Society for Medical Technology, 6(3), 183-185.
Langenbrunner, J., Cashin, C., & O'Dougherty, S. (Eds.). (2009). Designing and implementing health care provider payment systems: how-to manuals. World Bank Publications.
Lavis, J., Davies, H., Oxman, A., Denis, J. L., Golden-Biddle, K., & Ferlie, E. (2005). Towards systematic reviews that inform health care management and policy-making. Journal of health services research & policy, 10(1_suppl), 35-48.
Mathauer, I., & Wittenbecher, F. (2013). Hospital payment systems based on diagnosis-related groups: experiences in low-and middle-income countries. Bulletin of the World Health Organization, 91, 746-756A.
Or, Z. (2014). Implementation of DRG Payment in France: Issues and recent developments. Health policy, 117(2), 146-150.
Schreyögg, J., Stargardt, T., Tiemann, O., Busse, R. (2006). Methods to determine reimbursement rates for diagnosis-related groups (DRG): a comparison of nine European countries. Health Care Management Science, 9(3):215–23.
Scheller-Kreinsen, D., Geissler, A., & Busse, R. (2009). The ABC of DRGs in Europe Euro Observer. The Health Policy Bulletin of the European Observatory on Health Systems and Policies, Winter, 11(4).
Theurl, E., & Winner, H. (2007). The impact of hospital financing on the length of stay: evidence from Austria. Health policy, 82(3), 375-389.
Verulava, T. (2021). Access to Healthcare as a Fundamental Right or Privilege? Siriraj Med J, 73(10), 721-726.
Vogl, M. (2012). Assessing DRG cost accounting with respect to resource allocation and tariff calculation: the case of Germany. Health economics review, 2(1), 1-12.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
