New billing system in Dubai health care facilities from September
Diagnosis Related Group method of payment to ensure standard level of patient care
Dubai: Hospitals and clinics in Dubai will follow the new Diagnosis Related Group (DRG) method of payment from September 1, according to industry sources.
They said as part of streamlining the health care system, the DRG was to be implemented by the Dubai Health Insurance Corporation (DHIC) under the aegis of the Dubai Health Authority (DHA) in the first quarter of 2020 across all health care facilities in Dubai. However, owing to the current pandemic situation, it will be in September.
Many hospitals in Dubai have already completed pilot projects on DRG billing to understand how it will work in real time.
What is the DRG billing system?
The DRG system, which is an internationally vetted billing system, uses algorithms to fix base fees for treatments of a range of health conditions. The new payment system seeks to create specific codes for specific procedures and fix the cost as well as medicines and hospital stay duration to ensure that each patient get the basic benefit through health insurance coverage.
How will it work?
To provide an illustration, when a patient reports to a hospital or clinic with a particular condition that might require medication or surgery with inpatient care, all details regarding him as well as vital parameters are taken into account and placed in the system. If a doctor has to operate, he places the procedure under a set code taking into account the nature of the illness along with other variables such as patient’s age, complications and comorbidities (the presence of one or more conditions existing at once). These factors will help him to determine which algorithm the case will fall under. There is a corresponding payment schedule for each algorithm which will make it easy for insurance companies to reimburse.
The insurance then pays a bundled payment and under this, the cost of treatment, cost for medication and duration of stay are fixed. The system will allow hospitals to be graded according to their experience and performance. This will provide hospitals an opportunity to negotiate prices on a case-by case basis, higher than the base price depending on the grade they fall in, said industry sources from the health sector.
The system is meant to provide patients with a standard level of care with no room for overcharging or providing less than stipulated time in the event of hospitalisaton. The aim is to ensure complete transparency in billing systems.