Study the Implementation of Payment System Based on Diagnosis-Related Groups (DRGs) in Selected Hospitals of Hamadan province, Iran

Diagnosis-related group payment system is highly valuable for developing countries and governments that are seeking to appropriately control health costs and expanding public health coverage due to its impact on managing costs and increasing efficiency of hospitals. The present study aimed to investigate the implementation of this payment sysvem.

This cross-sectional descriptive-analytical study was performed on 34 hospital managers, Iranian health insurance managers, and clinical and financial experts of Hamadan province. In the first part, a researcher-developed questionnaire was used to assess the level of knowledge and attitude. In the second part, a checklist was used to assess how to record patients’ clinical-financial information in five public hospitals in the Hamadan province. Data were analyzed using descriptive statistics by Stata version 11.

Various factors were identified, including pros and cons, barriers and prerequisites of implementation, increasing the efficiency and quality of provided services after implementation, synchronization with insurance organizations, the use of this payment system for outpatients were mentioned. All public hospitals in the Hamadan province recorded financial and clinical information completely and appropriately using the International Classification of Diseases, versions 9 and 10.

Considering the limitation of resources and diversity of health staff, changing the payment system is difficult in all countries. However, preparing the executive staff and managerial support pave the way for changes in the payment system and help to address the resulting problems. According to the findings, it seems that the DRG payment system can be implemented after establishing necessary measures and providing appropriate infrastructure.