Sağlık Hizmetlerinde Geri Ödeme Modelleri: Teşhis İlişkili Gruplar ve Vaka Karması

Abstract

Aim: This study aims to describe the methods used in reimbursements made to healthcare providers, to inform detailed information about Diagnosis-Related Groups (DRG) and to calculate the case mix index of a public university hospital. Materials and Methods: In this study, all DRG clinical data of March 2015 were screened in a public university hospital located in Ankara. “Turkey’s Diagnosis-Related Groups Relative Value List” published by Diagnosis- Related Groups Department of The Ministry of Health was investigated for the relative values of relevant Diagnosis Related Groups data. In this study was used descriptive research method and it is also cross-sectional as it covers a specific period. DRG data obtained from the hospital is determined relative values of the relevant data. Data were analyzed in Excel, the hospital’s case mix index (CMI) was calculated. Results: The result of this study found that of the total 293 DRG data is calculated as the sum of the relative values of the respective data 260.28. This figure is calculated by dividing the total number of cases of hospital case mix index is calculated as 0.89. Conclusion: The hospital case-mix index value of 0.89 of the study because it is less than 1, it is concluded that the hospital looked to cheaper and less complex cases. In the line of these results, it can be said that establishing a DRG and Cost Analysis unit, having the global budget to cover all public and private health institutions and making reimbursements based on DRG + CMI would be beneficial for the hospital.

Keywords

• Reimbursement
• Hospital
• DRG
• Case Mix Index

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