Conference DRG Restart 2016: one more year to finish the project

The third year of conference dedicated to revitalisation of the Czech system of reimbursements of acute inpatient care was held on 9–10 November 2016 in the Prague Congress Centre. Representatives of healthcare providers and healthcare payers, health professionals and policymakers thus had yet another opportunity to get acquainted with the current state of the DRG Restart project and with the plans for the final year of its schedule.

14 Nov 2016

The conference took place under the auspices of Svatopluk Nemecek, MD, MBA (Minister of Health of the Czech Republic), Prof. Rostislav Vyzula, MD, PhD (Chairman of the Committee on Health of the Chamber of Deputies of the Parliament of the Czech Republic), Prof. Jan Zaloudik, MD, PhD (Chairman of the Committee on Health and Social Policy of the Senate of the Parliament of the Czech Republic), and Zdenek Kabatek, MSc (Director of the General Health Insurance Company of the Czech Republic).

The event was opened by invited representatives of the Czech health system, involving Prof. Jan Zaloudik, Petr Landa, MSc (Undersecretary of Health), and Petr Honek, MD (Deputy Director of the General Health Insurance Company of the Czech Republic). All three of them explained their views of the present and future role of DRG in the Czech healthcare system; furthermore, they agreed that step-by-step changes are necessary, and that evolution should be preferred to revolution.

The current state of the project DRG restart was presented by Assoc. Prof. Ladislav Dusek, PhD, Director of the Institute of Health Information and Statistics of the Czech Republic (IHIS). A large part of his address was dedicated to the so-called reference hospitals, which form an integral part of the project, and which in fact provide the only way as to how data from both clinical and economic practice of acute inpatient care can be collected. The establishment and running of a network of reference hospitals has been supported from the Operational Programme Employment, and final preparations are currently under way for a full data collection. Parallel to these activities, key methodical materials are being developed and finished in a close cooperation with experts from reference hospitals. Legislative support of this project, based on Acts No. 48/1997 Coll. and 372/2011 Coll., is no less important.

Stanislav Ziaran, MD, PhD, a representative of the Health Care Surveillance Authority (HCSA) from neighbouring Slovakia, was among those invited to this year’s conference. Dr Ziaran’s lecture in the introductory session made it possible for conference participants to compare the Czech and Slovak DRG systems not only from the point of view of contents, but also their state of implementation. The Slovak system is based on the German G-DRG and is markedly different from the Czech concept. However, the actual use of DRG system in reimbursements of acute inpatient care is likely to happen much sooner in Slovakia than in the Czech Republic.

Development of the Czech DRG classification system runs in several levels, and the conference programme paid appropriate attention to each of these levels. The medical part was introduced by teams of Tomas Pavlik, PhD, and Miroslav Zvolsky, MD. Both speakers demonstrated specific examples of how the newly developed classification systems should work, and what changes can be expected in comparison to the current state. All development takes place in cooperation with relevant expert medical societies, and a multilevel examination by both internal and external experts is guaranteed.

No less important is the economic part of the project, which is the responsibility of Marketa Bartunkova, MSc, and her team. Ms Bartunkova and Jan Linda, MSc (new manager of the DRG Restart project) together described the pilot data collection from reference hospitals, which had already been carried out, and pointed out problems to be solved before starting the full data collection. Important principles in the assessment of hospitalisation cases were also mentioned, such as a sufficiently large set of reference hospitals, minimisation of administrative burden of their staff, or a sufficient robustness and flexibility regarding potential changes.

Legislative aspects play – and will play – a key role in the development of the Czech DRG system, both during the current cooperation between IHIS and reference hospitals, and during the future implementation of the DRG system. This fact was clearly demonstrated by lectures of Vladimira Tesitelova, MSc (IHIS) and Radek Policar, MSc (Ministry of Health of the Czech Republic).

The conference programme gave ample scope for speakers beyond the project team. Representatives of six expert medical societies, who acted as consultants and opponents in development of the classification system, were also invited to speak at the conference. These experts were very convincing in their explanations as to why the current classification system for acute inpatient care in the Czech Republic needs to be reformed. They explained that within one group of procedures, very different procedures – in terms of required time, difficulty, facility equipment and doctor’s expertise – are equally appraised. This is the reason why larger hospitals are often economically disadvantaged while providing specialised care; moreover, specifics of paediatric medicine are largely ignored. Jiri Mrazek, MSc (General Health Insurance Company of the Czech Republic) presented the point of view of healthcare payers; and finally, Jan Michalek, MSc (Ministry of Health of the Czech Republic) provided the view of a health authority official.

The newly developed Czech DRG system – or anything else for that matter – is surely not a magic bullet which would solve the current problems encountered in acute inpatient care or in any other segment of the Czech healthcare system. However, lectures and discussions at the conference DRG Restart 2016 have shown that a redesigned DRG system provides an opportunity to set a fairer financing framework, and to help Czech hospitals provide a high-quality and modern medical care to their patients.

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