Diagnosis related groups (DRGS) as a financial management tool: A case study on surgical oncological cases in public hospital

Introduction: The DRGs system is considered one of the most important reforms in the field of health worldwide in the last 30-40 years, and is a modern mechanism for compensation and control of hospital costs, which is used by most developed countries in the world with individual variants. At the beginning of 2012, this method was introduced in Greece in the form of Hospital Consolidated Cost (KEN). Aim: To study the implementation of DRGs in Greece and to investigate the possibility of their use as a tool for coordinating Financial Management in the country’s hospitals. Case report: This study included the entire set of discharges from surgical departments of the “Theagenio” Anticancer Hospital of Thessaloniki in 2019. The reimbursement values of the examined KEN as well as their standard length largely strongly deviate from the actual figures leading to a simple proposal already made by other researchers: the application of micro-costing techniques better reflects the actual cost of treatment. It was also observed misclassifications hidden under the usual practice at public hospitals to link many cases to a few KEN codes or even one. The analysis also revealed differences in productivity and efficiency among surgical departments. It is rather complicated to assess the KEN system as a genuine DRG system as it has not followed its basic principles (cost weight, base rate, case mix index). However, the upcoming Gr-DRG system could be used as an important tool for coordinating financial management in Greek hospitals, presupposing the development of controlling and monitoring processes, internal and external comparison of hospitals (benchmarking), and adaptation of production processes for the benefit of the patient and the hospital. Thus, the new system should “reward” high-performance and high-profile hospitals treating more complex cases.