Comparing hospital compensation to actual costs based on the Greek Diagnosis-Related Group system in ophthalmology.

Purpose: The purpose of this study is to evaluate the effects of the new system of pricing medical services in the field of ophthalmology in Greece. In addition, it attempts to benchmark the system with respective interventions at an international level.

Materials And Methods: The study deals with the implementation of the new system, presenting systematic pairing of ophthalmic coding with other coded information regarding registration and management. Statistical data analysis is performed related to the cost and, finally, proposals are formulated to improve the current system.

Results: A significant difference is noted in the quantitative and qualitative characteristics of the Greek system compared with internationally applied Diagnosis-Related Group (DRG) systems in the field of ophthalmology. The proposed funding for ophthalmic inpatient cases mostly meets real needs and costs of hospitals for supplies. Complicated cases, mainly in cataract surgery, increase the real cost and may cause a deviation depending on the rate of complications. In these cases, the average cost was 673.28 ± 58.7&OV0556; as opposed to uncomplicated cases (346.78 ± 21.3&OV0556;), bearing a statistically significant difference (P < 0.001, Mann-Whitney test). The total compensation of the hospital was higher than the actual cost for surgical procedures covering the respective expenses.

Conclusion: Although the recently implemented compensation system for public hospitals mostly covers the actual cost for ophthalmic surgical cases, some deviations from the real needs are being identified. Several amendments could be applied to increase efficiency and improve the quality of health services provided by Greek hospitals.