The DRG Story: Transition to Europe and Beyond Miriam Wiley The Economic and Social Research Institute Dublin, Ireland The US health care system isa conspicuous failure..And yet American ideas-notably notions of competition-have been influential in a range of European countries. And American policy tools-for example,diagnosis-related groups-based systems of remuneration have been adopted. Rudolf Klein, AJPH, Jan 2003, Vol 93, No.1, p.63 Factors influencing dissemination of DRGs internationally n DRGs used on a national basis in US n DRGs first case mix management system to make transition from research to policy n National relevance could be assessed empirically Kimberly & de Pouvourville, 1993 Factors influencing dissemination of DRGs internationally (contd.) n Technology for using DRGs readily available at an affordable price n Consultation and technical assistance available from developers n DRGs flexible classification scheme n Refined DRGs required minimal additional investment Kimberly & de Pouvourville, 1993 Gateways to Europe and Australia n Late 1970s Bob Fetter spent a sabbatical at the Catholic University of Louvain (with Jan Blanpain) n 1979 French task force visit to Yale (following contact between Jean de Kervasdoue and John Kimberly) and in 1982 PMSI established after further Yale research visit n 1982 George Palmer (University of New South Wales) was a Visiting Professor at Yale University School of Management Health Policy Context Technical Context Internal & External Networks of Support Role of Key Constituents Fate of DRGs Path of Entry Effectiveness of Champions Kimberley & de Pouvourville, 1993 Milestones n 1983 introduction of US PPS legislation n 1984 meeting in Paris of representatives of 5 European countries interested in pursuing DRG-related research (France, Portugal, the Netherlands, Belgium, Ireland) n 1986 London conference following which PCS/E officially inaugurated n 1988 Sydney conference bringing together researchers and policy experts from Europe, Australian and US Geographical Penetration by early 1990s n By 1991, Portugal and Norway committed to using DRGs at the national level n Belgium, England, Finland, France, Italy, Spain, Sweden, Switzerland, Ireland involved in testing DRG applications n Germany and Denmark considered DRGs unsuitable for local use (subsequently reversed) Evolution Testing Applications Localisation? Data Coding Costing AN DRGs, HRGs For the outside world, the US health care scene is [therefore] a kind of supermarket where they can shop selectively. But having shopped, they also adaptthe crucial element is the local environment and context-and the extent to which imports fit, or can be made to fit, local needs Rudolf Klein, AJPH, Jan 2003, Vol 93, No.1, p.63 European Case Mix Classification System? National Case Mix Classification Systems? Coding Systems? Coding Schemes for Diagnoses & Procedures Case-Mix Classification Schemes Other Case-Mix Systems n Leistungsorientierte Krankenanstaltenfinanzierung (LKF) (Austria) n Health Resource Groups (HRGs) (England) n Diagnose Behandelings Combinatie (DBC) (The Netherlands) n Nord DRGs (The Nordic Countries) n G-DRGs (Germany) n Groupes Homogenes de Malades (GHM) (France) the innovation process virtually guarantees that change, not stability, is the norm and thus suggests that one should expect change in products as they mature Kimberley and de Pouvourville, 1993 Overview n The DRG approach now used throughout Western, Central and Eastern Europe, Australia, Asia, South Africa, North, Central and South America Overview (contd.) n An Australian footprint now evident alongside the original US model in many international applications n Increasingly development/adaptation of national systems more in evidence as data, expertise and technology available become more advanced. Overview (contd.) While the application of case-mix measures varies between countries, these initiatives have generally had significant implications in a number of areas, including the development of high quality activity and cost information systems, technology transfer and software adaptation/development. While the application of case-mix measures varies between countries, these initiatives have generally had significant implications in a number of areas, including the development of high quality activity and cost information systems, technology transfer and software adaptation/development. .... the point of irreversibility has been reached.. [this] irreversibility is lodged not in the DRGs per se but rather in the underlying logic. We believe that a significant shift has taken place in the way all parties to the health care process think about the products of the hospital, patterns of resource consumption within the hospital, and the way in which the production process should be monitored. (Kimberley 1993) Penetration of DRG/DRG-Type Applications The Ongoing Challenge Given the dynamic nature of health/hospital systems, the development of case-mix measures must be continually advanced to ensure that these techniques are responsive to increasing demands from innovation in technology and information systems, rising consumer expectations and the globalisation of service provision within the health care sector Given the dynamic nature of health/hospital systems, the development of case-mix measures must be continually advanced to ensure that these techniques are responsive to increasing demands from innovation in technology and information systems, rising consumer expectations and the globalisation of service provision within the health care sector The DRG Journey Continues ENJOY!