PMID- 10916607
OWN - NLM
STAT- MEDLINE
DCOM- 20000828
LR  - 20191104
IS  - 1386-9620 (Print)
IS  - 1386-9620 (Linking)
VI  - 2
IP  - 2
DP  - 1999 May
TI  - Has DRG payment influenced the technical efficiency and productivity of 
      diagnostic technologies in Portuguese public hospitals? An empirical analysis 
      using parametric and non-parametric methods.
PG  - 107-16
AB  - The use of Diagnosis Related Groups (DRG) as a mechanism for hospital financing 
      is a currently debated topic in Portugal. The DRG system was scheduled to be 
      initiated by the Health Ministry of Portugal on January 1, 1990 as an instrument 
      for the allocation of public hospital budgets funded by the National Health 
      Service (NHS), and as a method of payment for other third party payers (e.g., 
      Public Employees (ADSE), private insurers, etc.). Based on experience from other 
      countries such as the United States, it was expected that implementation of this 
      system would result in more efficient hospital resource utilisation and a more 
      equitable distribution of hospital budgets. However, in order to minimise the 
      potentially adverse financial impact on hospitals, the Portuguese Health Ministry 
      decided to gradually phase in the use of the DRG system for budget allocation by 
      using blended hospital-specific and national DRG case-mix rates. Since 
      implementation in 1990, the percentage of each hospital's budget based on 
      hospital specific costs was to decrease, while the percentage based on DRG 
      case-mix was to increase. This was scheduled to continue until 1995 when the plan 
      called for allocating yearly budgets on a 50% national and 50% hospital-specific 
      cost basis. While all other non-NHS third party payers are currently paying based 
      on DRGs, the adoption of DRG case-mix as a National Health Service budget setting 
      tool has been slower than anticipated. There is now some argument in both the 
      political and academic communities as to the appropriateness of DRGs as a budget 
      setting criterion as well as to their impact on hospital efficiency in Portugal. 
      This paper uses a two-stage procedure to assess the impact of actual DRG payment 
      on the productivity (through its components, i.e., technological change and 
      technical efficiency change) of diagnostic technology in Portuguese hospitals 
      during the years 1992-1994, using both parametric and non-parametric frontier 
      models. We find evidence that the DRG payment system does appear to have had a 
      positive impact on productivity and technical efficiency of some commonly 
      employed diagnostic technologies in Portugal during this time span.
FAU - Dismuke, C E
AU  - Dismuke CE
AD  - Department of Economics, Universidade do Minho, Braga, Portugal. 
      dismuke@eeg.uminho.pt
FAU - Sena, V
AU  - Sena V
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - Netherlands
TA  - Health Care Manag Sci
JT  - Health care management science
JID - 9815649
SB  - IM
MH  - Diagnosis-Related Groups/*economics
MH  - Diagnostic Services/*economics/statistics & numerical data
MH  - Efficiency, Organizational/*statistics & numerical data
MH  - Health Services Research
MH  - Hospitals, Public/economics/organization & administration/*statistics & numerical 
      data
MH  - Insurance, Health, Reimbursement
MH  - Models, Statistical
MH  - Portugal
MH  - Regression Analysis
MH  - State Medicine
MH  - Utilization Review
EDAT- 2000/08/01 11:00
MHDA- 2000/09/02 11:01
CRDT- 2000/08/01 11:00
PHST- 2000/08/01 11:00 [pubmed]
PHST- 2000/09/02 11:01 [medline]
PHST- 2000/08/01 11:00 [entrez]
AID - 10.1023/a:1019027509833 [doi]
PST - ppublish
SO  - Health Care Manag Sci. 1999 May;2(2):107-16. doi: 10.1023/a:1019027509833.