The process of evolution of medical services tariffs and reimbursements based on Diagnosis-Related Groups

Mobasheri, Mahmoud. and Mirzaeian, Razieh. and Shirvani, Mina. (2014) The process of evolution of medical services tariffs and reimbursements based on Diagnosis-Related Groups. World Applied Sciences Journal, 30 (12). pp. 1834-1838.


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Introduction: Diagnosis Related Groups (DRG) is a classification system used for the inpatients in which the inpatients who use similar resources are classified as one similar category. This classification is based on the following components: diagnosis codes, taken actions, age, complications, gender and the discharge status. This study intended to explore the universal approach for the evolution of this reimbursement and its challenges and benefits so that an appropriate strategy can be agreed for the reimbursement system in Iran. Methodology: This study of descriptive comparative nature was conducted in 2013 to shed some light on the evolution process of the DRG in the health care system. The data were gathered though using information resources including articles, books, magazines and valid web-sites. To obtain the strategies used in the selected nations, 110 articles were extracted from varied magazines and scientific resources. Then, the status of the nations on the development of this reimbursement system was compared so that the related obtained results can be used as guide for developing an appropriate strategy for Iran's repayment system. Findings: Based on the findings of this study, one of the criteria for development of DRG is its high penetration coefficient in terms of determining the accuracy of the row of the diagnosis, the accuracy of main diagnosis coding, the accuracy of the used codes and the condition of the patient at the discharge time. Using DRG, the speed of calculating the medical and healthcare services' costs increases, since checking the profile, the skillful coder is able to perform coding appropriately and rapidly and finally, the payment of costs can be done based on the respective codes. Conclusion: As a prospective payment system, DRG acts as a motivator for the service providers for decreasing the level of services and consequently, the patient's length of stay. © IDOSI Publications, 2014.

Item Type: Article
Additional Information: cited By 0
Uncontrolled Keywords: Diagnosis-related groups Indicator Reimbursement Quality
Subjects: WB Practice of Medicine > General diagnosis
Divisions: Faculty of Health > Department of Epidemiology
Faculty of Nursing and Midwifery
Reserach Vice-Chancellar Department > student research center
Depositing User: zahra bagheri .
Date Deposited: 01 Aug 2017 08:02
Last Modified: 02 Jun 2018 10:30

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