Investigation of the impact of DRG based reimbursement mechanisms on quality of care, capacity utilization, and efficiency- A systematic review

Introduction: The purpose of this systematic review was investigating the implementation outcomes of the diagnosis-related groups. Methods: In this study, articles evaluating the effect of DRG implementation published between 1983 and July 10, 2018, which were indexed in Scopus, PubMed, and EMBASE databases were retrieved. Two reviewers reviewed the retrieved literature and included articles. Results: Of 9834 retrieved articles, 21 related articles were finally identified and examined. The results of this study showed that a positive outcome of the implementation of the reimbursement system based on the DRG is the reduction of the average length of stay in the hospital. Not all hospitals reported a reduction in medical expenses after DRG implementation (57%). None of the evaluated studies reported an increase in mortality rate after the DRG implementation. Only 25% of the included studies reported an increased readmission rate. Most studies showed that this mechanism could transfer costs to other health centers. More than half of the studies reported reductions in the number of surgeries, hospitalization rates, and laboratory tests. Conclusion: The reimbursement system based on DRGs has different outcomes in different types of health care systems. This system reduced the intensity of the services and the length of stay.

Automated summary

The reimbursement system based on DRGs has different outcomes in different types of health care systems, but it generally reduces service intensity and length of stay.