Homogeneous patient groups as an advanced system for standardizing inpatient care billing

Abstract

Health-care financing, which is based on hospitalization cases of homogeneous patient groups, has gradually be-come the primary means of reimbursement of costs of acute inpatient care in most high-income countries in the world since the 1990s. The motives that underlie the development and implementation of homogeneous patient groups sys-tems in different countries differ, but they mainly relate to increasing the transparency and efficiency of treatment in health care institutions and to optimizing their management. The purpose of the survey was to study and interpret the case mix approach to the classification of patient hospital-ization cases in order to optimize a unified pricing system for hospital services, variations of which have been imple-mented in the variety of developed countries. The modern scientific literature, which addresses the issue of identifying groups, the prerequisites and the standards for their creation, was analyzed and interpreted for the Ukrainian reader. The content analysis, the systematic and comparative analysis, as well as the bibliosemantic method were used. The main part of the article describes the definition of homogeneous patient groups and the system of mandatory attributes that they must possess, outlines the common causes and stages of implementation of homogeneous patient groups in national health-care systems, as well as the general differences in the methods of calculating the actual rate of payment for the patient hospitalization case. It is noted that the countries in which national classification systems are implemented may vary greatly in the number of groups. Other studies show that in most European countries the number of groups increases over time after their implemen-tation. Thus, between 2005-2011, the number of groups in Germany increased 1.36 times, in England more than dou-bled, and in France quadrupled. The overall implication of this cost-reimbursement model in Europe increased the activity of health-care facilities and the national expenditure on health care, and, conversely, the use of homogeneous patient groups in the United States restrained the country’s expenditure on the industry. Clinicians and national health-care authorities in Ukraine are advised to consider the introduction of homogeneous patient groups and to examine the approaches of other countries to classifying and calculating the actual rate of hospitalization case to create a modern and effective national model of inpatient care cost-reimbursement in Ukraine.