Abstract
Diagnosis related groups for the low income, development and applicationInpatient services are complex and costly. The US Medicare, the elderly health benefit scheme, had faced uncontrollable expenses in the 1970s because the scheme reimbursed hospitals retrospectively. Diagnosis related group (DRG) was invented in the early 1980s to be used in a prospective payment system to control the rising cost. After it has been proved successful, DRG has migrated and been adopted into health care systems in many countries. Some use DRG on a case by case payment basis, some use DRG in a resource allocation formula and some use it to compare the hospitals' activities. DRG is considered non-foreign to the Thai health care context. Classifying cases into DRGs requires information that is readily available (diagnoses, operating room procedures, age, type of discharge). DRG can be used to predict the lengths of stay and resources used to treat patients in the hospitals, so we are able to use DRG for resource allocation, for case-based payment and for comparison between hospitals. Assigning patients into DRGs requires data on ICD-10 and ICD-9-CM (for diagnosis and procedure respectively)of individual patient. So far, research activities on DRG in Thailand based on the 10th revision of Health Care Financing Administration (HCFA-DRG). Relative weight for each DRG is estimated by using patient-based costing methodology and cost to charge conversion ratio, then compare the cost mean of each DRG to the average cost of all patients. After reviewing the weights from many piec of research results and with inpatient data from Ramathibodi hospitals, the final version of relative weights to be used in the Thai context is endorsed by the Health Insurance Office. The uses of DRGs are many folds. In 1997, allication of non-salary recurrent budget to 92 general and regional hospitals used the average relative weights to better reflect their case complexity and cost. The second example, relative weights for different schemes of the low income were used to estimate budget requirements if the Thai government were to propose a universal converage scheme to the majority of Thais. The third example, relative weights were used to evaluate hospital achievements. The future use of DRG within the global budget ceiling in the reform of civil servant medical benefit scheme should be cautiously laid out. Finally, if DRG is to be used in the Thai health care context, it needs to set the system that recalibration of DRG weight can be done systematically. The dataset for hospitals to report for each patient to be examined is the important strategy for continuity of the system. Finally, cost accounting studies in a few efficient hospitals need to be done to tell the true cost of providing care to each DRG.
