DRG Developments and uses in Thailand

1
?????????????????????????????????????

• ????????? ????????????
• ????????????? ?????????????????

2
???????

• ??????????????????????????????? (DRG version 1-3)
• ??????????????????????????????????????????
• ??????????????????????????????

3
?????????????????
4
DRG version 3

• ????????????????? 1,200 ?????
• ????????? Australian Refined DRG
• ??????????????????????????? (?????????? 5)
• ????? complication comorbidity
  ??????????????????
• ??????????????????????????????????????? 28
  ???????????
• ???????????????????? ???????????
• ????????????????????? (??? ICD-10 4
  ???????????????)

????????? ???????????? (2543)
5
DRG for MDC 01
DRG 01010 Craniotomy exc for Trauma WO
CC 01011 Craniotomy exc for Trauma W Minor
CC 01012 Craniotomy exc for Trauma W Moderate
CC 01013 Craniotomy exc for Trauma W Major
CC 01014 Craniotomy exc for Trauma W Extreme
CC ...
6
Patient Clinical Complexity LevelPCCL
Determintion
1. Patients data
Dx, Procedure, age, adm wt
2. CCL Determination ( for each SDx ) DC
SDx DC Col Table CC list
with CC excl. CC Row Table Col
CCL Matrix Row CCL(comorbidity
complication)
3. CCL Arrangement and Recursive Exclusion
4. PCCL Determination Using Formula or Table
7
Method for calibration

• Standardised charge for room and food by
  replacing reported charge with callos x200
  baht/day for teaching hospitals and callos x 100
  baht/day for other hospital
• RW is the mean of standardised charge for each
  charge divided by 10,000

8
Material

• Clinical data of 4.2 million admissions in 2001
  and 1.1 million in 2002
• Charge data of 640,109 in 2001 and 270,741 in
  2002 (gt0.8 and lt1.2 consistency)
• Charge data gt3,000 baht only 362,144 cases -gt
  average charge 12,848 baht

9
??????????????????????????????????????????????????
1 ( ??? 462 ?????)
????????? ???????????? (2543)
10
DRG version 2
???????????????????????? ?????????????????????????
????????????? ??????????????????? 42,774 ???
?????????????????????? 37,861 ??? ???????
34,911 ??? ????????? 90,845 ???
????????????? 67,181 ??? ???????????
?????????????????? 16,573 ???       
????????? ???????????? (2543)
11
Cumulative of cases by hospital type

DRG version 3
12
Cumulative RW by type of hospital

DRG version 3
13
???????????????????????????????????????????
14
??????????????????????????????????????? 100 ??

• ????????? (??????????) 5 ?????/??
• ??????????? 3 ?????/??
• ?????????????????? 16 ?????/??
• ??????????????????? 6 ?????/??
• ??????????? ???????? 29 ?????/??

15
????????????????????????????????????????

• ?????? 46 ?????/?? (????????????? 62 ?????/??)
  
• ???????? 45 ?????/?? (????????????? 81
  ?????/??)
• ????????? 33 ?????/?? (????????????? 38
  ?????/??)

16
????????????
17
?????????????????????????????

• ??????? 13 ????
• ?????????
• ?????????
• ???????????????????????
• ???????????????????????????????? main contractor

18
?????????????????????????????
1
2 3 4
5
10717 49.3 99.8
100 1344, 1108
10718 79.2 82.0
100 1036, 819
11184 3.1 100
100 3, 2

11185 82.5 100
100
11186 80.0
100 158, 115

11187 85.1 100
100 227, 191
11188 2.2 100
100 52, 44

• 1. ??????? 13 ???? 2. ????????? 3. ????????? 4.
  ??????????????????????? 5. ???????????????????????
  ????????? main contractor

19
???????????????????????????????????????

• Thai-Refined DRG
• Subacute Non-Acute Patient (SNAP) ????
  Psychiatric casemix
• Ambulatory Patient Group (APG)
• Chronic Risk Group (CRG)

20
3MHIS 2001
21
????????????? DRG ??? capitation
3MHIS 2001
22
DRG ????????????????

• ????????????????????????????????????????????
  ??????????? Activity based costing (ABC)
  ?????????
• ??????? bottom-up costing ????????????????????????
  ?? Benchmark ????????????????????????
• ???????????????????????????????????
  ???????????????????????? recalibrate
• ????????????????????????

????????? ???????????? (2543)
23
Cumulative charge by day (low outlier with
inlier charge)
24
Cumulative charge by day (low outlier with
inlier charge)
25
Access to cancer care, teaching hospital I
Half year Estimated on the whole year to
1999-2001
26
?????????????????????????????????????
27
??????????? Statin ??????????????????????
UNMET NEED Project
28
(No Transcript)
29
?????????? ?????????????????

• ???????????????????????????
• ????????????????????????????????????
• ??????????????????????????????????????????????
  (????????????????)
• ??????????????????????????????????????????????????
  ????

30
?????? 30 ??? ???????????????????????
Ultimate goals
First best Equity and efficiency Second best
Equity or efficiency