Dáil Éireann Debate, Thursday - 10 July 2014
184. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the extent to which the diagnostic-related groupings system is employed in the health service here; if there is scope to extend this system; the expected efficiencies and savings which could be expected from same; and if he will make a statement on the matter. [30468/14]
View answerDiagnosis Related Group (DRG) systems classify patients into distinct groupings which are clinically similar and consume similar health resources. Irish hospitals use the AR-DRG grouping system which groups each hospital's inpatient and daycase workload into 698 DRGs. Until the end of 2013, the main use of the DRG system was to adjust the budget allocations of acute public hospitals by up to 3% in line with the complexity of their casemix and their relative performance under the Casemix System. DRGs have also been used as a tool to assist with planning as well as monitoring and assessing performance within the acute hospital sector.
Since January, 2014 the DRG grouping system has been used to facilitate the introduction of a new prospective, case-based funding model for public hospital care called Money Follows the Patient. The new model involves moving away from inefficient block grant budgets to a new system where hospitals are paid for the actual level of activity undertaken. As such, hospitals will be funded based on the quantity and quality of the services they deliver to patients. They will be liberated, subject to overall budgetary ceilings, to pursue the most cost-effective means of achieving this standard of performance. Budgetary discipline will be delivered through the use of fixed budgets for MFTP activity.
The new model is being rolled-out on a phased basis and full implementation will take a number of years. The MFTP approach is initially being applied to inpatient and daycase activity in public hospitals. However, it is intended that the payment system will extend over time to cover other hospital activity and eventually evolve so that money can follow the patient out of the hospital setting to primary care. The work of the National Clinical Programmes will be central to the future development of the payment model so that care can be financed as a bundle/package across a variety of settings.
Encouraging hospitals to use the resources at their disposal more efficiently is one of the central objectives of the MFTP system. A recent pilot project, which implemented a MFTP model in the orthopaedic speciality, showed the positive impact that MFTP can have through productivity gains. Introduction of MFTP resulted in significantly reduced average lengths of stay, increased numbers of day of surgery admissions, and an increase in the number of discharges at the weekend. Crucially, these improvements were delivered while not raising any quality concerns.
