Diagnosis Related Groups: Approval and suitability for the Greek National Health System A. Tzavaras, B. Spyropoulos, R. Gruen. Abstract – The Diagnosis-Related Groups (DRGs), is a method that identifies patients with similar resources use, based on statistical evaluation of hospital records. Statistics provide the Diagnosis related consumed resources and, thus, they enable the calculation of an average patient’s case-cost. On the basis of the Hospital activity levels and case mix, the health authorities can allocate the annual hospital budgets, both, prospectively and retrospectively. The purpose of the present study is to determine whether the implementation of the DRGs as a refunding methodology is, both, welcomed and feasible in the Greek National Health System (NHS). The aim was to collect information on the attitude, the knowledge, the experience, and the acceptability of the DRGs, as well as, on the existence of the necessary infrastructure. Two methods were used: First, a questionnaire was designed and sent to the Departments of Administrative and Economic Affairs of 50 Hospitals, corresponding to the 38% of NHS- Hospitals, and to all of the 17 Regional Health Authorities. Second, a semi structured interview was designed for health professionals of the NHS, originating from different disciplines. The collected evidence revealed a relative low percentage of, first, familiarity with the DRGs, i.e. 45% for the questionnaire and 62.5% for the interviews, second, correlation between postgraduate education and familiarity (corr. = -0.66), third, familiarity and acceptability of the DRGs, and fourth, acceptability and suitability for the Greek NHS (corr. = -0.85). The Information Technologies (IT) infrastructure was found to be minimal in the Greek hospitals. The DRGs were ranked as the best method for approaching and refunding Hospital-care cost. The appropriateness of the DRGs approach in the Greek NHS, was criticized on the grounds of personnel resistance, lack of experience, ethical dilemmas, lack of political will to implement the DRGs, high initial investment cost, in both, NHS and health-insurance funds, lack of infrastructure, and finally, the existence of higher priorities for the Greek NHS. The study concluded that the implementation of DRGs in the NHS is a task to be considered, but before introducing it, the government should launch IT and Electronic Patient Record in the Hospitals. On the other hand, the Health-insurance organizations should train their personnel, on both, IT and the DRGs methodology, in order to, first, adapt the DRGs to the Greek settings, second, calculate cost weights and pre test the DRGs in some hospitals, to gain experience, and third, make decisions concerning the real cost of health care. All the above factors contribute to a long term plan for the employment of the DRGs in the Greek NHS. Keywords: Diagnosis Related Groups (DRGs), Health cost, Prospective- Retrospective budgets, Greek National Health System (G-NHS). A.Tzavaras, Technological Educational Institute of Athens, Medical Instrumentation Technology Department, GR122-10, Athens, Greece, corresponding author, email: tzavaris@otenet.gr. B. Spyropoulos, Technological Educational Institute of Athens, Medical Instrumentation Technology Department, GR122-10 Athens, Greece. R. Gruen, Alice Salomon Fachhochschule-University of Applied Sciences, Berlin, Alice-Salomon-Platz, D-12627 Berlin, Germany. I. INTRODUCTION The Diagnosis Related Groups (DRGs) is an internationally applied methodology for funding Health Services. It has been first applied in the USA in the 1980’s [1], and has gained popularity ever since. The Greek NHS (G-NHS), since its last reform in the 1990’s has been facing important economic problems due to the fact that the Government has shifted the economic burden from insurance funds, to government funded health services [2]. The G-NHS is funded through taxation and per- diem reimbursement. In contrast, the social insurance funds are only partially funded by the government. Employees and employers contribute in funding insurance organizations. The current study is trying to establish whether the introduction and application of DRGs in the G-NHS, is both welcomed and suggested by the health professionals. The aim was to collect information on attitude, knowledge, and experience, acceptability of DRGs and existence of supporting IT infrastructure. II. BACKGROUND A. History In the U.S.A. in the early 1970’s, Fetter [1] developed the DRG system to compare outcomes between hospitals. DRGs are now widely used as a method for classifying hospital patients, both, in terms of medical condition, and resource use [3]. The information gathered from DRGs is applied to a variety of fields, such as hospital management, health policy, health funding, hospital benchmarking, quality management and patient clinical management. In 1982 [4], acute-care general hospitals in New Jersey, USA, piloted a DRG-based, prospective payment system. In 1983 the Federal Government introduced nationally a five year transition to the current DRGs. The payment rate per hospital was based on inpatient diagnoses, and considered medical and surgical procedures, length of stay, teaching hospital adjustments, and patient demographic data. B. USA Medicare DRGs calculation The assignment of a discharged patient to a specific DRG is based on Major Diagnostic Categories (MDCs) [5]. In principle the price of each DRG is calculated by multiplying the relative cost weight of each DRG with the base rate which is equivalent to the national average cost per case. USA DRGs relative weights range from 0.1524 to 15.4629, where the weight of 1.00 equals the base rate. The relative weights are recalculated annually by considering the historic average costs of each DRG and adjusting charges to reflect current costs [4],[5].