Diagnosis Related Groups (DRGs)
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The Diagnosis Related Groups system classifies, for the purposes of reimbursement, the various inpatient healthcare cases in homogeneous groups in accordance with the clinical picture, their convergences as regards consumption/use of hospital resources and therefore hospitalisation costs.
In order to classify the cases into the various financially homogeneous groups, DRGs, the system uses mainly the demographic data of the beneficiary, the main diagnosis, any secondary diagnoses and the clinical procedures that were performed.
These data are recorded in “special” software in the form of codes, which processes them and then determines the DRG in which each case is classified. Each DRG has a predetermined Cost Weight based on the consumption of resources for the clinical procedures included in the specific DRG.
Cost weight, after being multiplied with a predetermined and pre-agreed with the bodies involved, Base Rate, calculates the reimbursement amount that the hospital will receive for each case classified in each DRG.
DRGs constitute an international best practice since they are successfully used by many national healthcare systems in the world, such as in Germany, Spain, the United Kingdom, the USA, Australia and many others.
This system makes it easier to foresee the use of resources required for each specific medical case and at the same time ascertains whether the hospitalisation period was longer or shorter than the foreseen one.
In addition, transparency and productivity are increased and at the same time unnecessary treatment costs are reduced and healthcare and treatment procedures are optimised.
The DRGs contribute to the strengthening of healthy competition between hospitals, a fact that is expected to become the basis for the increase of quality of healthcare services for the benefit of all beneficiaries.