Cross Border Healthcare in Europe and Diagnosis Related Groups: A series of Unfortunate Questions

Diagnosis Related Groups- DRGs are used to categorize patients according to the resources needed for their medication or hospitalization and their clinical characteristics. The groups the patient belongs to, determine the cost of the health services offered. The first grouping systems where developed in the early 80s from Robert Barclay Fetter και John D. Thompson in Yale University.

DRGs are also used in European Union and they are now considered as a tool to create homogeneity among the health systems of member states. But what does this mean?

A simple example is to pick an Italian, a Spanish, a British and a German patient. All of them  suffer from the same illness and each one of them chooses a hospital in his county. All of the previews hospitals may offer the same level of services and use same medical equipment and resources. So the cost will be the same. Obviously not. But why? Are the functional expenses of each organisation the reason? Maybe the pricing policy? Maybe the health policy of each government? There are various different reasons in each state that determine healthcare costs. And this creates opportunities such as Medical Tourism. Now my tooth hurts. Well, I have to visit a dentist, and I don’t mind travelling to another country to do so. Should I travel to the UK or Hungary? Let’s check prices first. Treatmentabroad has the following comparison table on its website.

	UK price	Hungary price
Tooth extraction	£90.00	£30.00
BriteSmile® Tooth Whitening	£475.00	£280.00
Root Canal Treatment	£200.00	£60.00
Porcelain Veneer	£500.00	£180.00
Branemark Dental Implant	£1,900	£800.00
Porcelain Crown	£500.00	£180.00

The price differences are significant. But it is still hard for me to choose.

Reinhard Busse (Prof. Dr. med. MPH FFPH) makes a similar price comparison in his presentation in EuroDRG final conference, Berlin, Germany (17/11/2011) Then he asks "If costs differ so much with treatment, what about the quality of care???". DRGs are not only a tool to homogenize costs, but also quality of services.

Most people say that “What you pay is what you get”. Others say, “Value for money”. That is totally right. Value for money, and not money for value. Price can not affect Quality in real. It only affects the perceived Quality. The best example is the JCI accredited hospitals in India, that offer perfect services, and they are 5-10 times cheaper than a European hospital.

So DRGs are the secret to achieve high quality of services and competitive pricing? No.

DRGs offer something very important for healthcare systems. They help with standardization of services. Each healthcare professional can use DRGs for his purpose, physicians to determine the procedures needed, financial managers to determine costs, operations managers to apply metric and benchmark with other organizations. So DRGs homogeneity is important, in country and in European level.

The EuroDRGproject may lead to pan-European DRGs, and my opinion is that this is one more step to common European health policy.

Greek DRGs at a glance.

DRGs are totally new in the greek health system. They are known as “KEN” and consist of 700 groups. These groups resulted from combining DRGs and  ICD-10 (International Classifications of Diseases). The Greek Ministry of Health intends to use DRGs for costing purposes, and they are also expected to decrease bureaucracy between public or private healthcare organizations and insurance organizations. The aplication project of DRGs in Greece has started in October 2011 for public hospitals, and private hospitals will have to join the project in the beggining of 2012. Change management is not easy in this case. Efforts towards Greek NHS reformation should also focus on Integration of Information Systems, and extensive training of healthcare professionals. 

So much discussion on DRGs and almost nothing about ICD-10. I am sure the video will explain ICD-10 better than me.