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The suitability of a DRG casemix system in the Maltese hospital setting

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  • Camilleri, Carl
  • Jofre-Bonet, Mireia
  • Serra-Sastre, Victoria

Abstract

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.

Suggested Citation

  • Camilleri, Carl & Jofre-Bonet, Mireia & Serra-Sastre, Victoria, 2018. "The suitability of a DRG casemix system in the Maltese hospital setting," Health Policy, Elsevier, vol. 122(11), pages 1183-1189.
    • Handle: RePEc:eee:hepoli:v:122:y:2018:i:11:p:1183-1189
    DOI: 10.1016/j.healthpol.2018.08.002
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    1. Azzopardi-Muscat, Natasha & Baeten, Rita & Clemens, Timo & Habicht, Triin & Keskimäki, Ilmo & Kowalska-Bobko, Iwona & Sagan, Anna & van Ginneken, Ewout, 2018. "The role of the 2011 patients' rights in cross-border health care directive in shaping seven national health systems: Looking beyond patient mobility," Health Policy, Elsevier, vol. 122(3), pages 279-283.
    2. Sebastian Hof & Andreas Fügener & Jan Schoenfelder & Jens O. Brunner, 2017. "Case mix planning in hospitals: a review and future agenda," Health Care Management Science, Springer, vol. 20(2), pages 207-220, June.
    3. Alexandra Bibbee & Flavio Padrini, 2006. "Balancing Health Care Quality and Cost Containment: The Case of Norway," OECD Economics Department Working Papers 481, OECD Publishing.
    4. Fourie, Carina & Biller-Andorno, Nikola & Wild, Verina, 2014. "Systematically evaluating the impact of diagnosis-related groups (DRGs) on health care delivery: A matrix of ethical implications," Health Policy, Elsevier, vol. 115(2), pages 157-164.
    5. Azzopardi-Muscat, Natasha & Aluttis, Christoph & Sorensen, Kristine & Pace, Roderick & Brand, Helmut, 2015. "The impact of the EU Directive on patients’ rights and cross border health care in Malta," Health Policy, Elsevier, vol. 119(10), pages 1285-1292.
    6. Katja Grašič & Anne Mason & Andrew Street, 2015. "Paying for the quantity and quality of hospital care: the foundations and evolution of payment policy in England," Health Economics Review, Springer, vol. 5(1), pages 1-10, December.
    7. Ghaffari, Shahram & Jackson, Terri J. & Doran, Christopher M. & Wilson, Andrew & Aisbett, Chris, 2008. "Describing Iranian hospital activity using Australian Refined DRGs: A case study of the Iranian Social Security Organisation," Health Policy, Elsevier, vol. 87(1), pages 63-71, July.
    8. Mikkola, Hennamari & Keskimaki, Ilmo & Hakkinen, Unto, 2002. "DRG-related prices applied in a public health care system--can Finland learn from Norway and Sweden?," Health Policy, Elsevier, vol. 59(1), pages 37-51, January.
    9. Jackson, Terri & Dimitropoulos, Vera & Madden, Richard & Gillett, Steve, 2015. "Australian diagnosis related groups: Drivers of complexity adjustment," Health Policy, Elsevier, vol. 119(11), pages 1433-1441.
    10. Reinhard Busse & Alexander Geissler & Anne Mason & Zeynep Or & David Scheller‐Kreinsen & Andrew Street & Reinhard Busse, 2012. "DO DIAGNOSIS‐RELATED GROUPS EXPLAIN VARIATIONS IN HOSPITAL COSTS AND LENGTH OF STAY? – ANALYSES FROM THE EURODRG PROJECT FOR 10 EPISODES OF CARE ACROSS 10 EuroPEAN COUNTRIES," Health Economics, John Wiley & Sons, Ltd., vol. 21, pages 1-5, August.
    11. Reinhard Busse & Jonas Schreyögg & Peter Smith, 2006. "Editorial: Hospital case payment systems in Europe," Health Care Management Science, Springer, vol. 9(3), pages 211-213, August.
    12. Reinhard Busse & Alexander Geissler & Anne Mason & Zeynep Or & David Scheller‐Kreinsen & Andrew Street & Alexander Geissler & David Scheller‐Kreinsen & Wilm Quentin, 2012. "Do Diagnosis‐Related Groups Appropriately Explain Variations In Costs And Length Of Stay Of Hip Replacement? A Comparative Assessment Of Drg Systems Across 10 European Countries," Health Economics, John Wiley & Sons, Ltd., vol. 21, pages 103-115, August.
    13. John C. Langenbrunner & Cheryl Cashin & Sheila O’Dougherty, 2009. "Designing and Implementing Health Care Provider Payment Systems : How-To Manuals," World Bank Publications - Books, The World Bank Group, number 13806.
    14. Azzopardi-Muscat, Natasha & Clemens, Timo & Stoner, Deborah & Brand, Helmut, 2015. "EU Country Specific Recommendations for health systems in the European Semester process: Trends, discourse and predictors," Health Policy, Elsevier, vol. 119(3), pages 375-383.
    15. Gong, Zhiping & Duckett, Stephen J. & Legge, David G. & Pei, Likun, 2004. "Describing Chinese hospital activity with diagnosis related groups (DRGs): A case study in Chengdu," Health Policy, Elsevier, vol. 69(1), pages 93-100, July.
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