Sağlık Hizmetlerinde Geri Ödeme Yöntemlerinden Teşhis İlişkili Gruplar

Abstract

Health institutions need to be financially sustainable for contiunity of delivery of health care. The method used in the reimbursement to healthcare providers directly affects the financial sustainability of the institutions. Therefore, it requires great attention that the decision-making process of methods of reimbursement used in healthcare systems of countries. In order to not to compromise on quality in delivery of health care, the reimbursement method used should be in a way to provide fair resource allocation among health institutions. In this study, it is aimed to explain the reimbursement methods used in healthcare servicesand to emphasize the importance of Diagnosis Related Groups-based reimbursement as an example of the case based payment method. The case mix index was calculated by using monthly Diagnosis Related Groups data of 2018 of a general hospital with group A2 dependent on Republic of Turkey Ministry of Health. The annual mean case mix index of the hospital was 1.01. On a monthly basis, the highest case mix index is 1.13 in December and the lowest case mix index is 0.91 in May. It is predicted that institutions will be able to make service delivery planning with more reliable data and obtain financing in line with the services they provide and both national and international comparisons can be made between health institutions when reimbursement of healthcare services by the use of Diagnosis Related Groups-based reimbursement method. Thus, it is considered that both the payer institution and the healthcare provider can be protected from the cost risks or other risks that may occur. (English) [ABSTRACT FROM AUTHOR]