Avaliação da produtividade de hospitais brasileiros pela metodologia do diagnosis related group (DRG) / Evaluation of the productivity of Brazilian hospitals by the methodology of diagnosis related group (DRG)

O gerenciamento de uma organização hospitalar exige provisionar seus custos/gastos com ferramentas que a aproximam da realidade. A tarefa de aferição da produtividade pode ser complexa e duvidosa, diversos métodos são experimentados e a utilização do DRG tem se mostrado eficiente, sendo utilizado na avaliação da produtividade através de desfechos assistenciais. Estudo transversal, avaliou 145.710 internações, no período de 2012-2014, utilizando a metodologia do DRG para medição de sua produtividade a partir da mediana do tempo de internação. Ao agruparmos todas as internações em clínicos (37,6%) e cirúrgicos (62,4%), várias análises puderam ser feitas de acordo com esse critério.O DRG como ferramenta para predição de dias de internação é uma alternativa eficiente, colaborando assim para o controle da produtividade que influencia diretamente nos gastos e custos dos produtos hospitalares e qualidade dos serviços.

The management requires a hospital organization to provision their costs/expenses with tools that approximate reality. The task of measuring productivity can be complex and uncertain, several methods are tested and the use of the DRG has been efficient, being used to assess the productivity through clinical outcomes. Cross-sectional study evaluated 145.710 hospitalizations in the period 2012-2014, using the DRG methodology for measuring productivity from the median length of hospitalization. When we group all hospitalizations in clinical (37.6%) and surgical (62.4%), multiple analyzes could be made according to this criterion. The DRG as a tool for prediction of hospital days is an effective alternative, thereby contributing tothe control of productivity that directly influences the costs of hospital expenses and product and service quality.

Forecasting the Future Reimbursement System of Korean National Health Insurance: A Contemplation Focusing on Global Budget and Neo-KDRG-Based Payment Systems

With the adoption of national health insurance in 1977, Korea has been utilizing fee-for-service payment with contract-based healthcare reimbursement system in 2000. Under the system, fee-for-service reimbursement has been accused of augmenting national healthcare expenditure by excessively increasing service volume. The researcher examined in this paper two major alternatives including diagnosis related group-based payment and global budget to contemplate the future of reimbursement system of Korean national health insurance. Various literature and preceding studies on pilot project and actual implementation of Neo-KDRG were reviewed. As a result, DRG-based payment was effective for healthcare cost control but low in administrative efficiency. Global budget may be adequate for cost control and improving the quality of healthcare and administrative efficiency. However, many healthcare providers disagree that excess care arising from fee-for-service payment alone has led to financial deterioration of national health insurance and healthcare institutions should take responsibility with global budget payment as an appropriate solution. Dissimilar payment systems may be applied to different types of institutions to reflect their unique attributes, and this process can be achieved step-by-step. Developing public sphere among the stakeholders and striving for consensus shall be kept as collateral to attain the desirable reimbursement system in the future.

Study economic efficiency of teaching hospitals of Qazvin university of medical sciences [1999-2007]

Hospitals as important sectors of health care system has special location in Health economic science. Increasing of the operational costs in hospital and limitation in financing cause that hospital as an economic firm use economic analysis and prepare effective using of resource and boost productivity. To analyze economic efficiency and resource allocation situation of teaching hospitals of Qazvin university of medical sciences [1999-2007]. This study was conducted in 2008. Need data [human and capital resource information] was collected from data center of research deputy of university and teacmg hospitals and registered at information sheets and then was analyzed by DEAP2 software and data evolvement analyze method. Average technical, pure and scale efficiency of centers during the period of study was appointedrespectively 0.90, 0.96 and 0.93 50 percent of centers were efficient for using of resource [Total Technical Efficiency [TTE]= 1]. Another 50 percent of centers had no efficient situation [TTE = 1]. Efficiency rate of studied centers was variable during the time of study and had not uniform trend. Human and capital resources were made 67 and 33 percent of total operational cast of centers respectively. The average of annual cost estimated per labor 30.1 xl0[6] and for capital resource 19.9 x 10[6] Rails. Labor and capital resources have more costs for hospital industry, therefore policy and decision makers must determine need for resource by using economic analysis and correct planning methods and then employ them, appoint optimal capacity for centers to service delivery, enhance positive efficiency indexes and distinguish the ways that is more effective in boosting of resource performance

Alternativas de financiamento de la atención médica en América Latina y el Caribe / Alternatives for the financing of health care in Latin America and the Caribbean

Dada a magnitude do problema de saúde nos países da América Latina e do Caribe, näo é possível cobrir o déficit de recursos financeiros necessários para prover assistência médica através de aumentos nos preços, ou com a adoçäo de medidas como o pagamento por serviços ou a cobrança do custo dos serviços. Faz-se necessário recorrer à política fiscal. Foi mostrado que é possível aumentar os recursos disponíveis para assistência médica, tanto por meio do aumento na arrecadaçäo de impostos, quanto pela tomada da decisäo política de aumentar a parcela da receita do Governo, destinada a financiar a assistência médica. Foi revista a experiência dos Fundos de Emergência Social e das operaçöes de troca de dívida por projetos na área de saúde como importantes fontes adicionais de recursos, especialmente para financiar o investimento