Diagnosis-Related Groups - towards Economic Efficiency: Operating Revenues and Costs Analysis

Abstract

On July 1, 2008, Narodowy Fundusz Zdrowia - NFZ (National Health Fund) introduced a new form of medical services contracting and financing - DRG-based payment system. The most important objectives related to the implementation of this payment system included an improvement in the economic efficiency and quality of medical services. The NFZ carried out the valuation of Diagnosis-related groups (point system) whose tariffs are equal for all types of hospitals, regardless of the region where they run their activity. Revenues from sale of medical services generated under contracts signed with NFZ and refunded on the basis of DRG are the main source of revenue (from 65% to 90%) for each hospital. The aim of this article is first to calculate the costs of medical services and then to analyze and compare them within the same DRG taking as example the groups F72 (inguinal hernia) and F73 (abdominal hernia) in order to verify if funding from NFZ covers all necessary costs occurred during hospitalization of patients. In order to achieve this aim, the author used the documentary analysis methodology (the literature review, the analysis of medical documents), as well as comparative analysis. (original abstract)