CoChat
Sign Up
Cited by 25Healthcare Systems and ReformsHealthcare Policy and ManagementHealthcare Systems and Practices

Transition to Diagnosis-Related Group (DRG) Payments for Health: Lessons from Case Studies

Open access
Bales, Sarah, Bredenkamp, Caryn, Kahur, Kristiina·2020·World Bank, Washington, DC eBooks
DOI 10.1596/978-1-4648-1521-8
Open this paper in CoChat — free accountOpen PDF

Abstract

This book examines how nine different health systems--U.S. Medicare, Australia, Thailand, Kyrgyz Republic, Germany, Estonia, Croatia, China (Beijing) and the Russian Federation--have transitioned to using case-based payments, and especially diagnosis-related groups (DRGs), as part of their provider payment mix for hospital care. It sheds light on why particular technical design choices were made, what enabling investments were pertinent, and what broader political and institutional issues needed to be considered. The strategies used to phase in DRG payment receive special attention. These nine systems have been selected because they represent a variety of different approaches and experiences in DRG transition. They include the innovators who pioneered DRG payment systems (namely the United States and Australia), mature systems (such as Thailand, Germany, and Estonia), and countries where DRG payments were only introduced within the past decade (such as the Russian Federation and China). Each system is examined in detail as a separate case study, with a synthesis distilling the cross-cutting lessons learned. This book should be helpful to those working on health systems that are considering introducing, or are in the early stages of introducing, DRG-based payments into their provider payment mix. It will enhance the reader's understanding of how other countries (or systems) have made that transition, give a sense of the decisions that lie ahead, and offer options that can be considered. It will also be useful to those working in health systems that already include DRG payments in the payment mix but have not yet achieved the anticipated results.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1596/978-1-4648-1521-8

Cites

0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The DRG payment system has become a significant component of healthcare payments in many countries to promote risk-sharing between healthcare providers and payers.

    “The payment system based on diagnosis-related groups, or DRGs, was designed to manage healthcare costs and maintain sustainable operations for inpatients and it has become a significant component of healthcare payments in many countries to promote risk-sharing between healthcare providers and payers1,2.”

    From Early prediction of diagnostic-related groups and estimation of hospital cost by processing clinical notes (2021) · cites this paper as [1]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

The publisher hasn’t deposited this paper’s reference list.

Research works printed but not linked: 23

  1. Busse, R., A. Geissler, W. Quentin, and m. Wiley. 2011. "Diagnosis Related Groups in Europe: moving towards Transparency, Efficiency, and Quality in Hospitals?" European Observatory on Health Systems and Policies.
  2. Duckett, S. 2008. "Casemix Development and Implementation in Australia." In The Globalization of Managerial Innovation in Health Care, edited by G. Kimberly de Pouvourille and T. d'Aunno, 231-53. Cambridge, UK: Cambridge University Press.
  3. Turner, L., and S. D. Short. 1999. "George Rupert Palmer -DRG Carrier and Champion." Australian Health Review 22 (2): 86-102.
  4. Willcox, S. 2005. "Buying Best Value Health Care: Evolution of Purchasing among Australian Private Health Insurers." Australia and New Zealand Health Policy 2 (1): 6. Accessed November 15, 2018, at http:/www.anzhealthpolicy.com/content/2/1/6.
  5. Busse, R., and m. Blümel. 2014. "Germany: Health System Review." Health Systems in Transition 16 (2): 1-296.
  6. Klein-Hitpaß, U., and D. Scheller-Kreinsen. "Policy Trends and Reforms in the German DRG- Based Hospital Payment System." Health Policy 119 (3): 252-57.
  7. Džakula, A., A. Sagan, N. Pavić., K. Lončarek, and K. Sekelj-Kauzlarić. 2014. "Croatia: Health System Review." Health Systems in Transition 16 (3): 1-162.
  8. Voncina, L., T. Strizrep, and A. Džakula. 2007. "The Introduction of DRGs in Croatia." EuroHealth-London 13 (1): 4-5.
  9. Busse, R., and m. Blümel. "Germany: Health System Review." Health Systems in Transition 16 (2): 1-296.
  10. Busse, R., A. Geissler, W. Quentin, and m. Wiley. 2011. "Diagnosis Related Groups in Europe: moving towards Transparency, Efficiency, and Quality in Hospitals?" European Observatory on Health Systems and Policies.
  11. Duckett, S. 2008. "Casemix Development and Implementation in Australia." In The Globalization of Managerial Innovation in Health Care, edited by G. Kimberly de Pouvourille and T. d'Aunno, 231-53. Cambridge, UK: Cambridge University Press.
  12. Džakula, A., A. Sagan, N. Pavić, K. Lončarek, and K. Sekelj-Kauzlarić. 2014. "Croatia: Health System Review." Health Systems in Transition 16 (3): 1-162.
  13. Fetter, R. B., and J. D. Thompson. 1965. "The Simulation of Hospital Systems." Operations Research 13 (5): 689-711.
  14. Ibraimova, A., B. Akkazieva, A. Ibraimov, E. manzhieva, and B. Rechel. 2011. "Kyrgyz Republic: Health System Review." Health Systems in Transition 13 (3): 1-152.
  15. Jian, W., m. Lu, K. Y. Chan, A. N. Poon, W. Han, m. Hu, and W. Yip. 2015. "Payment Reform Pilot in Beijing Hospitals Reduced Expenditures and Out-of-Pocket Payments per Admission." Health Affairs 34 (10): 1745-52.
  16. Jian, W. Y., m. Lu, T. Cui, and m. Hu. 2011. "Evaluating Performance of Local Case-mix System by International Comparison: A Case Study in Beijing, China." International Journal of Health Planning and Management 26 (4): 471-81.
  17. Jian, W., m. Lu, W. Han, and m. Hu. 2016. "Introducing Diagnosis-Related Groups: Is the Information System Ready?" International Journal of Health Planning and Management 31 (1): E58-68.
  18. Klein-Hitpaß, U., and D. Scheller-Kreinsen. 2015. "Policy Trends and Reforms in the German DRG-Based Hospital Payment System." Health Policy 11 (3): 252-57.
  19. Kutzin, J., A. Ibraimova, m. Jakab, and S. O'Dougherty. 2009. "Bismarck meets Beveridge on the Silk Road: Coordinating Funding Sources to Create a Universal Health Financing System in Kyrgyz Republic." Bulletin of the World Health Organization 87: 549-54.
  20. Turner, L., and S. D. Short. 1999. "George Rupert Palmer-DRG Carrier and Champion." Australian Health Review 22 (2): 86-102.
  21. Vončina, L., T. Strizrep, and A. Dzakula. 2007. "The Introduction of DRGs in Croatia." EuroHealth-London 13 (1): 4.
  22. Vončina, L., T. Strizrep, m. Bagat, D. Pezelj-Duliba, N. Pavić, and O. Polašek. 2012. "Croatian 2008-2010 Health Insurance Reform: Hard Choices toward Financial Sustainability and Efficiency." Croatian Medical Journal 53 (1): 66-76.
  23. Willcox, S. 2005. "Buying Best Value Health Care: Evolution of Purchasing among Australian Private Health Insurers." Australia and New Zealand Health Policy 2 (1): 6. Accessed November 15, 2018, at http:/www.anzhealthpolicy.com/content/2/1/6.

Cited by

Sorted by citations

Related

Authors
Bales, S., Bredenkamp, C., & Kahur, K.
ORCID
Bales, Sarah
Venue
World Bank, Washington, DC eBooks
Publisher
Washington, DC: World Bank
Published
2019-12-17
DOI
10.1596/978-1-4648-1521-8
OpenAlex
W2995766055
Cited by
25
References
0
Citations by year
2025: 3 · 2024: 7 · 2023: 9 · 2022: 2 · 2021: 2 · 2020: 2
FWCI
1.65
Type
book
Language
en
Open access
Licence
other-oa
Locations
  • World Bank, Washington, DC eBooks (publishedVersion)
  • The World Bank Open Knowledge Repository (World Bank) (submittedVersion, other-oa)
Topics
  • Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
  • Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Practices
Keywords
diagnosis-related groups, case-based payment, hospital payment reform, Medicare, Australia, Thailand, Germany, Estonia, Croatia, China, Russia, health system transition, payment design, health policy, institutional change

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review