SCH planning patient classification scheme

By Noimot Olayiwola/Staff Reporter The Supreme Council of Health is planning to introduce a patient classification scheme called diagnosis related groups (DRGs) or case mix concept, in order to reward performing hospitals. The concept, also known as activity-based funding, is expected to take off alongside the launching of the National Social Health insurance scheme. DRGs provide a means of relating the type of patients a hospital treats (its case mix) to the costs incurred by the hospital. DRGs are assigned based on international classification of diseases (ICD) diagnoses, procedures, age, sex, discharge status, and the presence of complications or co-morbidities. Activity-based funding system is a concept that measures the hospitals’ performances in order to reward their initiatives that increase efficiency in their services. The funding also serves as an information tool that allows policy makers to understand the nature and complexity of health care delivery in the country. “As part of the National Health Strategy, the SCH has been working to introduce activity-based funding through the National Health insurance scheme and the first patient to avail the insurance scheme will also be the first to benefit from the case mix concept, which we will be launching about the same time,” Dr Faleh Mohamed Hussain Ali, assistant secretary general for policy affairs at SCH, said yesterday. The official said that the move was “necessary step to encourage both efficiency and efficacy to ensure that members and healthcare providers have access to a transparent, high quality healthcare”. He stressed that providers will be paid according to their activities, which means based on health care services they provide for each patient as no annual budget will be allocated for them. “The SCH is adopting this initiative, which is new, under which patients will be diagnosed and financed in group in what we call the DRGs and their provider will be paid based on this activity,” he said. Meanwhile, the SCH yesterday signed an agreement with Europe-based Patient Classification Systems International (PCSI) to host the latter’s 30th annual conference in Doha next year. It will be the first time the PCSI event will be held in the Middle East. Previous events were held largely in Europe, North America and Australia. The agreement was signed by Dr Ali and PCSI president Poul Erik Hansen. Around 300 delegates, comprising specialists including academia, officials of health ministries, hospitals and non-governmental organisations from around the world, are expected to attend the three-day event. The conference will see workshops and plenaries focused on the development of the case mix concept in different parts of the world. “With the National Health insurance scheme gearing up for launch shortly, we felt it would be appropriate to host the 2014 event in Doha to build on shared experiences and to expand on the development of the case mix concept,” Dr Ali added. Hansen explained that patients will benefit from the case mix as there will be improved quality of care and help reduce length of hospital stay aside resulting in better health outcomes. “I am impressed with the healthcare that Qatar has built up. It can inspire many others. It is therefore gratifying that the SCH makes it possible to arrange a PCSI case mix conference in 2014 for the first time in the Middle East,” he said. Candidate nations normally wait around 10 years before they are able to host the conference, which is organised as a joint effort of the PCSI and a local organisation in the host country’s healthcare sector involved in case mix, he added. SCH National Health insurance scheme project manager Husein Reka said that all hospitals including the private sector will benefit from both the health insurance scheme and the case mix concept.