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PhilHealth Delegation Joins Experts’ Meet for DRG Development and Reforms October 17, 2018

In a separate presentation, Baltazar detailed the efforts being undertaken by the Philippine health sector to progress the development of a DRG provider payment system. She cited meaningful collaborations with development partners –the European Union (EU), Thailand, and the WB.

“The EU provided valuable assistance in designing a 5-year road map that laid out the elaborate steps needed to shift towards a DRG payment system. In addition, the Union had contributed in building an organizational structure and identifying human resource requirements to meet the demands of the transition,” Baltazar revealed.

On the other hand, Thailand was chosen to share its expertise to simulate Philippine data using the Thai DRG grouper system. A grouper is a software package that assigns a DRG specific to the patient’s episode of care. The grouper uses data that reflects the principal diagnosis and comorbidities coded in the International Classification of Diseases (ICD) classification, age, sex, surgical procedures, and length of stay and other relevant information that would then become the basis of payment to health care providers.

As to the collaboration with the WB, Baltazar said, “The World Bank is willing to validate the implications of adopting the Thai DRG or another existing grouper. They will also help us do an in-depth review of the All Case [Rates] system. We need hard evidence on the quantitative and qualitative aspects of the All Case Rates to encourage our policy-makers to shift [to DRG].”

The participating countries recognized their own shortcomings in implementing a DRG-driven provider payment method. A prominent challenge was developing a grouper system that effectively catalogues medical conditions and surgical procedures. Some of the factors affecting system development were data gathering and coding standards. Other challenges such as transitional strategies and operational application also came into play.

Triin Habicht, a health financing and DRG expert from Estonia, offered ways to successfully manage risks associated with the employment of DRG. She pointed out that a timely monitoring system must be used to detect unexpected practices and, in turn, pave the way for necessary adjustments. Habicht was adamant on the quality of DRG coding and insisted that the participants must conduct trainings, streamline guidelines, and strengthen controls for preferred outcomes.

Payment adjustments, budget ceilings, and aligned payment incentives across different care settings were among her recommendations to influence the attainment of a DRG-based payment scheme in the region.

Transitioning to another method of health care purchasing system is already a daunting task for PhilHealth and the DoH, let alone the rest of Southeast Asia. Impossible, some would say. Unmanageable, some would agree.

What occurred here was a collective show of support to an agenda which aims to ward off financial exhaustion during medical predicaments. The employment of a DRG payment mechanism is a huge step towards Universal Health Care as it promotes a highly-effective and sustainable approach to health care financing. The DRG guarantees fair costs on the part of the insurer and appropriate incentives to health care providers; serving the best interests of everyone involved in caring for the sick.

Ultimately, policy makers play a huge role in securing the success of this endeavor. Achievement of desired results will prove difficult without the support of each nation’s government and might result to a delay in the implementation of a payment standard that can potentially become the benchmark of social health care excellence.

As the meeting closed, the participants decided to have a continued collaboration among themselves in an effort to keep tabs on each other’s progress and afford assistance to those in need, thereby forming an allegiance committed to propel a health care financing built upon the principles of DRG into realization.

Plans were hatched, partnerships were forged, and progress was promised at the conclusion of such productive convention. Finally, the group agreed to a succeeding meeting. In the Philippines, maybe? Let’s see. (END) (JJ Rico)

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PhilHealth Delegation Joins Experts’ Meet for DRG Development and Reforms