The system is a tool to support budgetary discipline in healthcare, Dr. Drenski stated at Kapital Digital Health Forum

The system of diagnostic-related groups (DRG) as a mechanism for financing hospital care allows a fairer allocation of funds and helps to improve the quality of activities. This was said by Dr. Iavor Drenski, MD, Manager of Uni Hospital, at the conference Digital Health Forum, organized by Kapital and HealthPR on May 17, 2022. Dr. Drenski took part in the panel „Application of Digitalization for the benefit of patients and healthcare facilities“ with a speech on effective and well-established methods for financing and control of costs and quality in hospital care.

„One of the most complex processes in the economy is to evaluate the hospital service due to the uniqueness of each patient,“ explained Dr. Drenski. The perfect method has not yet been discovered, but in the world practice the financing through DRG is confirmed as the most appropriate. In Bulgaria, its introduction has been underway since 1997, but clinical pathways have been used as a funding mechanism up to date. They were created to maintain the quality of medical institutions, but in Bulgaria they were adapted as a system for hospital care reimbursement, which had to be temporary, Dr. Drenski recalled. Another major weakness of clinical pathways is that they require very complex and not very accurate reporting.

Diagnostically-related groups combine similar diseases or procedures for which a similar resource is spent. They are a powerful tool and a guarantee for effective cost control. Their specificity consists in the relative weights – they show the ratio between the various diseases in relation to the resources and the volume of activities that need to be performed. „Through DRG we will have a much fairer distribution of resources between individual diseases and procedures. In this way we can build a case-mix index of hospitals – we will know which treat severe cases and which are structural determinants of the health system“, said Dr. Drenski. Thanks to the case mix of hospitals, patients can be referred to those medical facilities for which the highest indicators and results in the treatment of individual diseases have been documented.

Another positive is that DRGs require a transparent accountability system and provide a tool for controlling the healthcare budget. It is applied according to a formula in which the basic value is essential – what is the public budgetary framework for health care for the year. „The baseline can be updated to maintain the ratio between individual DRGs, while paying for hospital care remains within the budget,“ said Dr. Drenski.

DRGs are also a tool for quality control and improvement, due to the fact that in this system the doctor sees in the patient not a clinical path, as it is now, but a person with a health issue and all his needs. The doctor’s goal is to cover the entire process of medical care, treating not only the major disease but also the comorbidities. The more multidisciplinary the patient is treated, the higher is the level of reimbursement. DRGs report not only the volume of activity performed, but also assess the age, accompanying conditions, complications, etc.

The system of diagnostic-related groups allows quality control of the hospital outcome, that is not applied in our country yet. It is also a specific and reliable tool for in-hospital management, as it is easy to find problematic structures, activities that generate more costs than expected for a given DRG. Benchmarking between hospitals can also be carried out and thus the hospital management can discover where the facility is located in terms of cost and quality indicators