The use of valuations of healthcare services in other countries (basic benefits basket) in the tariffing process

Magdalena Fedoryszak-Rodź; Maria  Świderek; Norbert Tyszka

Titles

Abstract

The Agency for Health Technology Assessment and Tariff System is national institution supervised by Minister of Health. Agency is an advisory body in the reimbursement process. One of the Agency’s roles is setting a tariff for publicly funded healthcare services. Determining the cost of medical services is one of the most important conditions for valuating these tariffs.

As in most European countries, the system of financing in-patient care in Poland is based on the Diagnosis Related Group system (DRG). DRG systems were created to increase efficiency in the use of available resources, and consequently to improve the quality of medical care. In order to compare the method and level of financing healthcare services with their equivalent abroad, the Agency analyzes information from other countries, especially those with GDP per capita similar to that of Poland. The Agency searches for patient group classification methods, payment methods, the shape of services and all factors affecting the valuation of services.

The article describes the Polish inpatient services system against the background of solutions functioning in the world. The pricing process was presented, with particular emphasis on the process of obtaining data on foreign tariffs and their impact on the construction and pricing of healthcare services in Poland.

* Przygotowanie do wydania elektronicznego finansowane w ramach umowy 637/P-DUN/2019 ze środków Ministra Nauki i Szkolnictwa Wyższego przeznaczonych na działalność upowszechniającą naukę.

The Agency for Health Technology Assessment and Tariff System is national institution supervised by Minister of Health. Agency is an advisory body in the reimbursement process. One of the Agency’s roles is setting a tariff for publicly funded healthcare services. Determining the cost of medical services is one of the most important conditions for valuating these tariffs.

As in most European countries, the system of financing in-patient care in Poland is based on the Diagnosis Related Group system (DRG). DRG systems were created to increase efficiency in the use of available resources, and consequently to improve the quality of medical care. In order to compare the method and level of financing healthcare services with their equivalent abroad, the Agency analyzes information from other countries, especially those with GDP per capita similar to that of Poland. The Agency searches for patient group classification methods, payment methods, the shape of services and all factors affecting the valuation of services.

The article describes the Polish inpatient services system against the background of solutions functioning in the world. The pricing process was presented, with particular emphasis on the process of obtaining data on foreign tariffs and their impact on the construction and pricing of healthcare services in Poland.

Keywords

świadczenia zdrowotne, koszty, wycena, taryfikacja / medical service, costs, valuation, setting tariffs

medical service, costs, valuation, setting tariffs

References

1. Kludacz-Alessandri M., Popytowe i kosztowe aspekty wyceny świadczeń zdrowotnych, w: Kludacz-Alessandri M., Model wyceny świadczeń zdrowotnych dla lecznictwa szpitalnego, Wolters Kluwer, Warszawa 2017: 17–57.

2. Ustawa z dnia 27 sierpnia 2004 roku o świadczeniach opieki zdrowotnej finansowanych ze środków publicznych (Dz.U. z 2019 roku poz.1373).

3. Tan Siok Swan et al., DRG systems in Europe: Variations in cost accounting systems among 12 countries, “European Journal of Public Health” 2014; 24 (6): 1023–1028.

4. Kobel C. et al., Systemy DRG i zbliżone systemy kwalifikacji pacjentów w Europie, w: Busse R. et al., Jednorodne

grupy pacjentów w Europie. W stronę przejrzystości, efektywności i jakości w szpitalach, Narodowy Fundusz Zdrowia – Centrala, Warszawa 2013: 55–79.

5. https://www.3m.com/3M/en_US/health-information-systems-us/providers/grouping-and-classification/apr-drgs/(accessed: 18.07.2019).

6. https://www.ihpa.gov.au/publications/development-australian-refined-diagnosis-related-groups-ar-drg-v90 (accessed: 18.07.2019).

7. https://app.reimbursement.info/drgs?years=2019&mdcs=24 (accessed: 18.07.2019).

8. https://www.atih.sante.fr/methode-alternative-la-comparaison-des-couts-et-des-tarifs-campagne-tarifaire-2018 (accessed: 18.07.2019).

9. http://www.norddrg.net/norddrgmanual/NordDRG_2012_NC/index.htm (accessed: 18.07.2019).

10. https://improvement.nhs.uk/resources/national-tariff/ (accessed: 18.07.2019).

11. Zarządzenie nr 77/2019/DSOZ Prezesa Narodowego Funduszu Zdrowia z dnia 27 czerwca 2019 roku zmieniające zarządzenie w sprawie określenia warunków zawierania i realizacji umów w rodzaju leczenie szpitalne oraz leczenie szpitalne – świadczenia wysokospecjalistyczne.

12. https://www.sozialministerium.at/site/Gesundheit/Gesundheitssystem/Krankenanstalten/LKF_Modell_2019/Kataloge_2019 (accessed: 18.07.2019).

13. https://www.hspm.org/countries/netherlands25062012/livinghit.aspx?Section=3.7%20Payment%20mechanisms&Type=Section (accessed: 18.07.2019).

14. Czach K. et al., Polska: Jednorodne Grupy Pacjentów – polskie doświadczenia z DRG, w: Busse R. et al., Jednorodne grupy pacjentów w Europie. W stronę przejrzystości, efektywności i jakości w szpitalach, Narodowy Fundusz Zdrowia – Centrala, Warszawa 2013: 389–408.

15. Kludacz-Alessandri M., Zasady rachunku kosztów i wyceny świadczeń zdrowotnych w wybranych krajach europejskich ‒ analiza porównawcza, w: Kludacz-Alessandri M., Model wyceny świadczeń zdrowotnych dla lecznictwa szpitalnego, Wolters Kluwer, Warszawa 2017: 142–177.

16. Agencja Oceny Technologii Medycznych i Taryfikacji, Metodyka taryfikacji świadczeń opieki zdrowotnej w AOTMiT, http://www.aotm.gov.pl/www/wp-content/uploads/taryfikacja/Metodyka_taryfikacji/Metodyka_taryfikacji_swiadczen_opieki_zdrowotnej_w_AOTMiT.pdf (accessed: 18.07. 2019).

17. Błaszczyński A., Słownik pojęć ekonomicznych (Glossary of Economic Terms), Szkoła Zarządzania Uniwersytetu Jagiellońskiego, Kraków 1995.

18. Błaszczyński A., Słownik ekonomiczny dla przedsiębiorcy w warunkach rynkowych, Znicz, Szczecin 1994.

Information

Information: Public Health and Governance, 2019, Volume 17, Issue 4, pp. 241 - 258

DOI: https://doi.org/10.4467/20842627OZ.19.025.12187

Article type: Original article

Titles:

Polish:

The use of valuations of healthcare services in other countries (basic benefits basket) in the tariffing process

English:

The use of valuations of healthcare services in other countries (basic benefits basket) in the tariffing process

Authors

Magdalena Fedoryszak-Rodź

Agency for Health Technology Assessment and Tariff System, Warsaw, Poland

Maria Świderek

Agency for Health Technology Assessment and Tariff System, Warsaw, Poland

Norbert Tyszka

Agency for Health Technology Assessment and Tariff System, Warsaw, Poland

Published at: 2019

Article status: Open

Licence: CC BY-NC-ND

Percentage share of authors:

Magdalena Fedoryszak-Rodź (Author) - 33%

Maria Świderek (Author) - 33%

Norbert Tyszka (Author) - 34%

Article corrections:

-

Publication languages:

English

View count: 861

Number of downloads: 686

<p> The use of valuations of healthcare services in other countries (basic benefits basket) in the tariffing process</p>

Pobierz pełny tekst

Titles

Abstract

Keywords

References

Information

Authors