Implementation experience with DRG-based payments
In Japan in 2010, the MHLW started the Quality Improvement Project to improve the quality of medical care through three hospital organizations: the Japan Hospital Association (JHA), the National Hospital Organization and the All Japan Hospital Association. The Project Committee was established to set quality indicators for the JHA. In 2011, 11 quality indicators, including patient satisfaction and inpatient mortality, were calculated and the results published on the JHA website. There are a total of 25 quality indicators for hospitals, with 13 indicators related to DPC payment (JHA, 2014). These 13 monitoring indicators for DPC hospitals are shown in Table 5.
Table 5: Monitoring indicator for DPC/PDPS hospitals in Japan Categories
Outcome (5)
Process (8)
N.
Indicators
1
Re-hospitalization in the first 6 weeks after discharge
2
Aspirin prescribed within 2 days after admission
3
Aspirin prescribed at discharge
4
Beta-blocker prescribed at discharge
5
Statin prescribed at discharge
6
ACEI (Angiotensin-Converting Enzyme Inhibitor) or ARB (Angiotensin Receptor Blocker) prescribed at discharge
7
ACEI or ARB prescribed
8
Antithrombotic therapy by end of hospital day 2
9
Discharged on antiplatelet therapy
10
Anticoagulation therapy for atrial fibrillation/flutter
11
Early rehabilitation for ischemic stroke patients
12
Relievers for inpatient asthma
13
Systemic corticosteroids for inpatient asthma
Source: JHA (2014) available https://www.hospital.or.jp/e/qip/
In the Republic of Korea, the Health Insurance Review & Assessment Service, which is the organization responsible for the review of claim data and assessment of quality, has introduced 18 types of monitoring indicators (see Table 6). It has been mandatory for hospitals to report this information since DRG payments were implemented for all hospitals (HIRA, 2014).
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