The evolution of drg system in italy: the it-drg project
Marino Nonis, Luigi Bertinato, L Arcangeli, Chiara Cadeddu, A Palinuro, L Frattura, GL Merlino, E Verdini, Lucia Lispi, Walter Ricciardi · European Journal of Public Health · 2018
Since 1978 Italy has a universalistic health system (National Health Service-SSN).The hospital network (data for 2016) has 752 public and 595 private accredited facilities, 215.064 hospital beds, 8.172.274 acute inpatients, and 454.573 accredited post-acute. The 1992 reform of the NHS iintroduced a system of remuneration of prospective hospitals, based on the classification of the Diagnosis Related Groups (DRG), almost entirely translated from US experience. Since its effective implementation in 1995, the system has been subject to irregular maintenance: adoption of v. 10;v.19 and v. 24 of the HCFA/CMS DRG; tariff updates in 1997 and 2012, with the exception of some regions. In 2011 the ‘It-DRG Project' started to develop a system for measuring and enhancing hospital admissions for acute illnesses, representative and specific of the Italian reality. A system that also provides tools for its continuous maintenance, with the aim of contributing to the improvement of hospital governance, allocation of resources, appropriateness, and quality of care. The new IT-DRG will be characterized by: 1) new classification of the groups (starting from v.24 of the CMS DRG), with a modular weighing system improving the predictive capacity of the Italian costs, which foresees 373 final groups compared to the 538 currently used (-30,67%); 2) classification of the diagnosis ICD-10-IM (Italian Modification), which integrates the 2016 version of the ICD-10 OMS and which consists of 19.030 codes, compared to 12.432 of the ICD9CM-2007 currently in use (+ 53,07%); 3) Italian Classification of Procedures and Interventions (CIPI), which integrates and modifies the previous one, with about 5.400 codes compared to 3.700 used up to now (+ 54,51%); 4) a system of relative weights associated with It-DRG and the respective ‘correction factors', defined on the basis of data collected on a sample of hospitals, according to the mixed approach to the case-mix costing, created ad hoc. Key messages: The new IT-DRG will contribute to the reduction of costs and better allocation of resources for NHS. IT-DRG could be one of the pillars for the survival of Italian universalistic health system.