Improvement of the Efficiency of Reimbursement in the Drug Related Groups’ System - การพัฒนาประสิทธิภาพระบบการเบิกชดเชย ค่าบริการสาธารณสุขในระบบ Diagnosis Related Groups

Abstract

        The objective of this study was to improve effectiveness of reimbursement in the drug related groups (DRGs) system. It was conducted in 3 steps in Khon Kaen Hospital during in 2012-2015: (1) situation analysis, (2) implementing improvement activities, and (3) evaluation. Data were obtained through the collection of number of cases with untimely reimbursement throughout the routine process in the hospital, of which there were 5 phases; and identied the underlying reasons of the delay. It was found that in 2012 there were 57.64% of the patient charts that had a delay in the first phase (price setting at the patient wards), 50.15% in phase 2 (chart summary by physicians), 33.24% in phase 3 (medical record auditing), 19.59% in phase 4 (medical record registration), and 3.32% in phase 5 (diagnosis coding). The overall delay was found in 0.84% of the patient records, causing the loss of 81 million baht. The causes of the delay were identified to be incompleteness or loss of patient files, high workload of personnel, and low efficient hard ware and software. Efforts to improve the process included the development of patient file tracking system, electronic chart summary system for the convenience of attending physicians, exchange of experiences using social media networking, improvement of information and communication system, and adding of over-time staff to work on the diagnosis coding. Evaluation after the improvement revealed that the reimbursement processing of all 78,266 patient charts was timely (100.00%). The improvement was a result of collecting the lessons learnt from the situation analysis, and applying efforts to utilyze advanced information technology, pre-audit via electronic filing and experience sharing concept. In addition, regular monitoring of the process could continue to improve effectiveness of healthcare reimbursement system.

Key words: drug releated groups (DRGs), reimbursement system