The Peruvian Hospital System is undergoing changes in the financial arena. Prospective payment mechanisms are being considered in order to increase the efficiency of the Ministry of Health’s facilities. To advance this discussion, Project 2000 has studied the applicability of case mixture measurement tools such as Diagnostic Related Groups (DRGs) and Healthcare Related Groups (HRGs) to the Peruvian environment. Two regional hospitals are involved in a Project 2000 pilot experience aimed at constructing and validating a prospective payment system based on HRGs.
DRGs or HRGs are used in developed countries for several purposes that include understanding and analyzing cost issues at the local level, providing performance based management, and setting cost standards at the national level, among others. However, the utility of these tools has not been previously proven in medium-to-low technology environments such as those of Peruvian hospitals.
Overcoming the current quality-of-information deficiencies and increasing the management skills of health personnel are major challenges. In this pilot experience, a specific training program to improve the hospital information flow has been developed. After creating a sufficiently large database of inpatient records, a HRG tariff structure was established and a prospective global budget was estimated for each hospital. At the end of the pilot experience the impact of the new payment mechanism on efficiency, quality, and administrative costs will be assessed.
Learning Objectives: 1. Analyze the applicability of HRGs to hospitals in developing countries. 2. Discuss several mechanisms and strategies to improve the quality of clinical information. 3. Describe the impact of a prospective payment mechanism on costs and quality of hospital services
Keywords: Financing, Health Service
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.