Diagnosis Related Groups DRGs in Thailand:

1
Diagnosis Related Groups (DRGs) in Thailand
The Third Expansion Phase in 1997
S Pannarunothai, MD, PhD Buddhachinaraj Hospital
2
DRG Development in Thailand
The Third Expansion Phase in 54 hospitals
DRG and hospital efficiency
DRG for the low income group
Accident DRG
3
Phase of DRG Development
Inpatient Data
Simulation

Ready?
4
Health Benefit Coverage of Thai Citizens
No insurance
Low income Scheme
5
Civil servant
Government subsidy/budget to each benefit scheme
2,000
1,800
1,600
1,400
Social Security
1,200
1,000
Low income
800
Health Card
No insurance
600
400
200
0
?
6
Civil Servant Scheme Social Security Low
income Health Card, etc
Fee-for service Capitation Global Budget DRG?
Others
Compulsory
Public Financing
Tax
Providers
Out of pocket
DRG?
Personnel
7
Source of Data for the Second Phase
Electronic records (.dbf) of inpatients from
regional, provincial and community hospitals
Data were recorded by Stat version 2 (MOPH)
or SSN2 (Social Security Office), orvarious
other home-made softwares
748,842 cases were available for analysis
8
Index for comparison
DRG Index (average relative weights) Five most
common DRGs Number of DRGs in one hospital
9
The Third Phase is to compare DRG Grouper
ICD10 ICD-9-CM
ICD10 OPCS-4
AP-DRG 3
Thai-DRG
DRG Index
10
DRG weights derived from research on DRG for the
low income
where there is no Thai RW, the weight is
estimated by
RW 0.88 HCFARW - o.11 HCFALOS 0.06 APLOS
0.52
R-square 0.39
11
Ability to Allocate DRG ( of total records)
R-square 0.27

• DRG in Thailand The Third Expansion Phase in 1997

12
Casemix Index (DRG index)
R-square 0.92

• DRG in Thailand The Third Expansion Phase

13
Characteristics of Non-meaningful AP-DRGs
R-square 0.85

• DRG in Thailand The Third Expansion Phase

14
Diagnoses of non-meaningful AP-DRGs that can be
classified
15
Degree of Specialization by Number of DRGs
R-square 0.90

• DRG in Thailand The Third Expansion Phase

16
Five most common AP-DRGs
183 Esophagitis, gastroent, agegt17 wo CC
777 Esophagitis, gastroent, agelt18 wo CC
371 Caesarean section wo CC
468 Extensive OR procedure unrelated to
principal Dx
422 Viral illness, FUO agelt18
17
Five most common HCFA-DRGs
373 Vaginal delivery wo complicating Dx
183 Esophagitis, gastroent, agegt17 wo CC
184 Esophagitis, gastroent, agelt18
422 Viral illness, FUO agelt18
81 Simple pneumonia pleurisy agelt18 wo CC
18
DRG Index of General Hospitals Participating in
the Second and the Third Phases
19
DRG Index of Regional Hospitals Participating in
the Second and the Third Phases
20
DRG index of Community Hospitals,AP-DRG vs
HCFA-DRG
21
What we have learned from the Third Expansion
Phase in 1997?

• Data available, but must be improved and
  standardised
• Grouper must be more efficient and correct

22
Minimal Data Set for Inpatients
PATXX.DBF
RFIXX.DBF
DXIXX.DBF
IPDXX.DBF
AN, C9
HCODE, C12
AN, C9
HN, C9
REFER, C12
HN, C9
DIAG, C5
AN, C9
REFERTYP,C1
CHANGWAT, C2
DXTYPE, C1
WARDDSC, C4
AMPUR, C2
DRDX, C6
DATEADM, D8
OPIXX.DBF
DOB, D8
TIMEADM, C4
AN, C9
SEX, C1
DATEDSC, D8
OPER, C4
MARRIAGE, C1
DROP, C6
TIMEDSC, C6
OCCUPA, C3
DATEOUT, D8
DATEIN, D8
DSCS, C2
NATION, C2
TIMEOUT, C4
TIMEIN, C4
23
Minimal Data Set for Patient Billing
PATXX.DBF
INSURXX.DBF
CID, C16
CHTXX.DBF
HN, C9
NAME, C32
HCODE, C12
RC_NO, C9
INSCL, C2
DATEIN, D8
HN, C9
HN, C9
SUBTYPE,C2
DATEEXP, D8
CHANGWAT, C2
AN, C9
AMPUR, C2
DATE, D8
CHAXX.DBF
Billing
DOB, D8
TOTAL, N7
HN, C9
SEX, C1
AN, C9
PAID, N7
MARRIAGE, C1
DATE, D8
PTTYPE, C2
OCCUPA, C3
CHGITEM, C4
NATION, C2
AMOUNT, N7
24
FUTURE PLAN TO ADMINISTER CLAIM DATA of the Civil
Servant Medical Benefit Scheme
ADMINISTRATION
ACCOUNTING
PERSONNEL
BILLING
INVENTORY
X-RAY
DRUGS
LAB
OPD
A/D/T
IPD
MEDICAL SERVICES
25
Flow of BMDS
Hospitals Health Care Facilities
Basic Minimal Data Set
Internet
CSMBS
THCFA
FUTURE PLAN TO ADMINISTER CLAIM DATA
26
Kakwani index of health care financing

• K index by billing -0.39123
• K index by payment rules -0.52849
• K index by pay -0.18674