JSSM  Vol.6 No.5 , December 2013
Medical Stakeholders’ Views on the Use of Packaged Charging Based on the Diagnosis-Related Group (DRG) in the Proposed Healthcare Reform
ABSTRACT

The second stage consultation of healthcare reform in Hong Kong was launched in late 2010. One of the key features in the healthcare reform is the use of packaged charging based on Diagnosis-Related Group (DRG) structure, for reimbursement of medical fees in order to enhance cost certainty and transparency in private healthcare services. The objective of the study was to investigate the comments, concerns and suggestions of medical practitioners and private hospitals about medical pricing based on DRG. A survey completed by 1100 medical practitioners, seven focus groups with 42 medical practitioners and six hospital administrators participated was conducted. Generally, the participants believed that DRG was more applicable to straight-forward and one-off treatment procedures. Those working in the private sector and non-Family Medicine specialists were more concerned about the desirability and feasibility of DRG, and the potential of control of pricing in private market. The practice of DRG-based pricing method in certain specialties and cases which required multiple examinations and procedures for diagnosis were discussed. Concerns about doctors’ selection of cases, upcoding and gaming on the charging system, as well as the high administration cost were also raised.


Cite this paper
F. Wong, F. Chan and S. Liu, "Medical Stakeholders’ Views on the Use of Packaged Charging Based on the Diagnosis-Related Group (DRG) in the Proposed Healthcare Reform," Journal of Service Science and Management, Vol. 6 No. 5, 2013, pp. 283-292. doi: 10.4236/jssm.2013.65032.
References
[1]   Census and Statistics Department, “Thematic Household Survey Report No. 50,” Census and Statistics Department, Hong Kong SAR, 2013.

[2]   Hospital Authority, “Annual Report 2010-2011,” Hospital Authority, Hong Kong SAR.

[3]   Food and Health Bureau, Hong Kong SAR, “Your Health Your Life: Healthcare Reform Consultation Document,” Food and Health Bureau, Hong Kong SAR, 2008.

[4]   Food and Health Bureau, Hong Kong SAR, “My Health My Choice: Healthcare Reform Second Stage Consultation Document,” Food and Health Bureau, Hong Kong SAR, 2010.

[5]   R. F. Averill, J. H. Muldoon, J. C. Vertrees, N. I. Goldfield, R. L. Mullin, E. C. Fineran, et al., “The Evolution of Casemix Measurement Using Diagnosis Related Groups (DRGs),” 3M Health Information Systems Research Report 5-98, 1998.

[6]   S. Saint, J. Rose, A. S. Lichter, S. Forrest and L. F Mc-Mahon, “Shifting Costs from High-Cost to Low-Cost Diagnosis-Related Groups?” Evaluation & The Health Professions, Vol. 25, No. 3, 2002, pp. 259-269.
http://dx.doi.org/10.1177/0163278702025003001

[7]   F. H. Roger France, “Case Mix Use in 25 Countries: A Migration Success But International Comparisons Failures,” International Journal of Medical Informatics, Vol. 70, No. 2, 2003, pp. 215-219.
http://dx.doi.org/10.1016/S1386-5056(03)00044-3

[8]   P. Hensen, T. Furstenberg, T. A. Luger, M. Steinhoff and N. Roeder, “Case Mix Measures and Diagnosis-Related Groups: Opportunities and Threats for Inpatient Dermatology,” European Academy of Dermatology and Venereology, Vol. 19, No. 5, 2005, pp. 582-588.
http://dx.doi.org/10.1111/j.1468-3083.2005.01258.x

[9]   R. E. Mechanic, “Opportunities and Challenges for Episode-Based Payment,” The New England Journal of Medicine, Vol. 365, No. 9, 2011, pp. 777-779.
http://dx.doi.org/10.1056/NEJMp1105963

[10]   CMS.gov., Centers for Medicare & Medicaid Services, “New Medical Services and New Technologies.”
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/newtech.html

[11]   R. P. Ellis and T. G. McGuire, “Hospital Response to Prospective Payment: Moral Hazard, Selection, and Practice-Style Effects,” Journal of Health Economics, Vol. 15, No. 3, 1996, pp. 257-277.
http://dx.doi.org/10.1016/0167-6296(96)00002-1

[12]   L. von Brasch, “Implementing Diagnosis-Related Groups (DRGs),” EHMA Annual Conference, 2009.
http://www.ehma.org/files/090625_EHMA_DRG_final.pdf

[13]   H. Edelstein, “Correspondence: The Prospective Payment System and Discharge Diagnoses for Coronary Heart Disease,” The New England Journal of Medicine, Vol. 330, 1994, pp. 578-579.
http://dx.doi.org/10.1056/NEJM199402243300821

[14]   A. R. Assaf, K. L. Lapane, J. L. McKenney and R. A. Carleton, “Possible Influence of the Prospective Payment System on The Assignment of Discharge Diagnoses for Coronary Heart Disease,” The New England Journal of Medicine, Vol. 329, No. 13, 1993, pp. 931-935.
http://dx.doi.org/10.1056/NEJM199309233291307

[15]   Chinese Times, 2010.
http://www.nstyle.url.tw/fina/index.php?option=com_content&task=view&id=544&Itemid=2

[16]   C. Pope, S. Ziebland and N. Mays, “Qualitative Research in Health Care: Analysing Qualitative Data,” British Medical Journal, Vol. 320, 2000, pp. 114-116.
http://dx.doi.org/10.1136/bmj.320.7227.114

[17]   Department of Health, “Executive Summary of 2009 Health Manpower Survey on Doctors,” DH, the Government of the Hong Kong Special Administrative Region, 2009.
http://www.dh.gov.hk/textonly/English/statistics/statistics_hms/files/sum dr09.pdf

[18]   The Health Foundation Inspiring Improvement, “Competition in Healthcare,” UK, 2011.
http://www.health.org.uk/media_manager/public/75/Research%20scan%20-%20competition%20in%20healthcare%20(April%202011).pdf

[19]   Medicare Payment Advisory Commission, “Chapter 8 Using Market Competition in Fee-for-Service Medicare,” In: Report to the Congress: Variation and Innovation in Medicare, MedPAC, Washington DC, 2003, pp. 131-146. http://medpac.gov/publications/congressional_reports/June03_Ch8.pdf

[20]   P. Schuetz, W. C. Albrich, I. Suter, B. L. Hug, M. Christ-Crain, T. Holler, et al., “Quality of Care Delivered by Fee-for-Service and DRG Hospitals in Switzerland in Patients With Community-Acquired Pneumonia,” Swiss Medical Weekly, Vol. 141, 2011, Article ID: w13228.

[21]   H. Kuwabara and K. Fushimi, “The Impact of a New Payment System with Case-Mix Measurement on Hospital Practices for Breast Cancer Patients in Japan,” Health Policy, Vol. 92, No. 1, 2009, pp. 65-72.
http://dx.doi.org/10.1016/j.healthpol.2009.02.010

[22]   W. H. Rogers, D. Draper, K. L. Kahn, E. B. Keeler, L. V. Rubenstein, J. Kosecoff, et al., “Quality of Care before and after Implementation of the DRG-Based Prospective Payment System: A Summary of Effects,” JAMA, Vol. 264, No. 15, 1990, pp. 1989-1994.
http://dx.doi.org/10.1001/jama.1990.03450150089037

[23]   B. H. Gilman, “Hospital Response to DRG Refinements: The Impact of Multiple Reimbursement Incentives on Inpatient Length of Stay,” Health Economics, Vol. 9, No. 4, 2000, pp. 277-294.
http://dx.doi.org/10.1002/1099-1050(200006)9:4<277::AID-HEC513>3.0.CO;2-1

[24]   B. Ljunggren and P. Sjoden, “Patient Reported Quality of Care before vs. after the Implementation of a Diagnosis Related Groups (DRG) Classification and Payment System in One Swedish County,” Scandinavian Journal of Caring Sciences, Vol. 15, No. 4, 2001, pp. 283-294.
http://dx.doi.org/10.1046/j.1471-6712.2001.00046.x

[25]   CMS CERT Team, “Medicare Fee-for-Service, 2012 Improper Payments Report,” Centers for Medicare & Medicaid Services, Baltimore, 2012.
http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/CERT/Downloads/MedicareFeeforService2012ImproperPaymentsReport.pdf

[26]   M. A. Rosenberg and M. J. Browne, “The Impact of the Inpatient Prospective Payment System and Diagnosis-Related Groups: A Survey of The Literature,” North American Actuarial Journal, Vol. 5, No. 4, 2001, pp. 84-94. http://dx.doi.org/10.1080/10920277.2001.10596020

[27]   S. E. Campbell, D. G. Seymour, W. R. Primrose and ACMEPLUS Project, “A Systematic Literature Review of Factors Affecting Outcome in Older Medical Patients Admitted to Hospital,” Age and Ageing, Vol. 33, No. 2, 2004, pp. 110-115.
http://dx.doi.org/10.1093/ageing/afh036

[28]   F. Oyebode, S. Cumella, G. Garden and S. Binyon, “Diagnosis-Related Groups: Implications for Psychiatry,” Psychiatric Bulletin, Vol. 14, 1990, pp. 1-3.
http://dx.doi.org/10.1192/pb.14.1.1

[29]   J. T. English, S. S. Sharfstein, D. J. Scherl, B. Astrachan and I. L. Muszynski, “Diagnosis-Related Groups and General Hospital Psychiatry: The APA Study,” American Journal of Psychiatry, Vol. 143, 1986, pp.131-139.

[30]   M. Moran, “Hospitals Wait to See New Payment System’s Effects,” Psychiatric News, Vol. 39, No. 23, 2004, pp. 5-46.
http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=108133&RelatedNewsArticles=true

[31]   Feeley & Driscoll Health Care Services Group, “Psychiatric Hospital Prospective Payment System (PPS),” Feeley & Driscoll, P.C., Massachusetts.
http://www.fdcpa.com/Healthcare/Psychiatric%20Hospital%20PPS%20Final%20Rule%20FY07.pdf

[32]   M. Lunger, B. Dredge, A. Rose, C. Roebuck, E. Plamper, K. Lauterbach and the Working Group, “Using Diagnosis-Related Groups,” European Journal of Health Economics, Vol. 49, 2004, pp. 287-289.

[33]   Office of Technology Assessment, “Chapter 4 Effects of DRG Payment on Technological Change in Medicine,” In: Diagnosis Related Groups (DRGs) and the Medicare Program: Implications for Medical Technology: A Technical Memorandum, US Congress, Office of Technology Assessment, OTA-TM-H-17, Washington, DC, 1983.

 
 
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