Akademik Veri Yönetim Sistemi
Turk Hijyen ve Deneysel Biyoloji Dergisi, cilt.82, sa.4, ss.579-596, 2025 (Scopus, TRDizin)
Objective: Reimbursement methods are important for the provision and continuity of health services. Reimbursement methods significantly affect elements such as quality and efficiency in the provision of health services. In addition, the size and diversity of the services provided by health institutions are also affected by reimbursement systems.Although there are many different reimbursement mechanisms for health service providers, case-based payment-DRG (Diagnosis Related Groups) is among the reimbursement methods used in terms of efficient use of resources and reimbursement according to costs. In this respect, reimbursement methods are explained in general terms in the study and the case-based-DRG method is discussed in detail. Methods: In the study, case mix indexes (CMI) were calculated with the DRG data of 27 hospitals located in Ankara. The hospitals studied were evaluated according to their role groups and the severity levels and cost requirements of the cases were compared. In addition, the actual allocations sent according to the global budget in the studied hospitals were compared with the budget allocations formed according to the DRG-CMI and the differences between them were emphasized. The findings obtained as a result of the study indicate that reimbursement based on case-by-case basis is important for the financial sustainability of healthcare providers. Results: BMI values of Group A hospitals were higher than Group B and C hospitals and A role group hospitals among the hospitals located in Ankara were affected negatively as role group by failure to perform planning according to DRG-CMI in 2023. C role group hospitals are the hospitals most positively affected. If planning were performed according to DRG-CMI the allowance distribution table of the hospitals would be formed very differently. Since the allowance planning performed according to DRG-CMI takes into consideration the complexity and costs of the cases, it shall lead to a more correct allowance distribution for A group hospitals compared to B and C group hospitals. Conclusion: The Ministry of Health hospitals in the province of Ankara were analyzed by being divided according to the DRG data and role groups and CMI calculations were performed in this study. As expected, CMI values of A role group hospitals were found higher compared to the B and C group hospitals. In the case that reimbursement is made according to DRG-CMI, it is observed that A role group hospitals dealt with more severe and complex cases compared to the other role groups and needed higher allowance in terms of source requirement.