THE CORRELATON ANALYSYS OF RELATIVE VALUES OF DRGS and THE HEALTH SERVICE TARRIFS in PRIVATE HEALTH INSURANCE SYSTEM in TURKEY

Year 2019, Volume: 1 Issue: 2, 21 - 33, 06.05.2019

Gizem Gençyürek , İlker Köse

Abstract

Diagnostic Related Groups (DRG) is used to
classify patients / cases that have similar services in the treatment as they
have similar diagnoses. The costs of the DRG cases are represented by a
numerical value called "relative value". Initially developed for
grouping hospital costs on the basis of diagnosis, DRG started to be taken as
reference widely by insurance companies in the case based payment model. The
first study about the DRG in Turkey is initiated in 2005 with public-university
cooperation and has carved an important role in the global budget
implementation of Ministry of Health (MoH) since 2009 using the Australian DRG
model. However, any work related to the DRG in the private health insurance
sector in Turkey has not been conducted. The payments of private hospitals by
the private insurance companies are based on the pay for service payment model
and the service prices are calculated mostly considering the minimum wage tariffs
of the Turkish Physicians Association (TPA). Although some arrangements are
done on the relative values by the MoH regarding the wages in the public
sector; there has been no study of how the relative values ​​are in line with
the prices in private hospitals. This study aims to measure the correlation
between the DRG relative values of Turkey and the health care service prices
that private hospitals charge to private health insurance companies. The data
set, gathered by CompuGroup Medical in a TUBITAK project includes the damage
files and their corresponding DRGs. The correlation between damage amounts and
relative values of 2.144 files is measured as 0,41. Secondly, the correlation
between the average damage amounts of the 235 DRGs and the relative value was
also measured as 0.43. Thus, the relationship between the health care service
prices of the private hospitals charged to private insurance companies and the
DRG relative values ​​used by the MoH has been measured to be weak.

Keywords

Diagnosis Related Groups, Turkish Medical Association, relative value, correlation analysis

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