[Ordinary hospitalisation, day surgery and one-day surgery: appropriateness and economic considerations in the DRG era]

Abstract

Italian Law No. 502 dated 1992 regarding the "Reorganisation of the Discipline in Matters of Public Health" and the introduction of the DRG (diagnosis-related groups) system in Italy in 1993 were very important steps in the establishment and implementation of the Management and Economic Autonomy of Hospitals. Since 1/1/2003, in the Lombardy Region, the Italian Version of the ICD-9-CM (International Classification of Diseases--9th revision--Clinical Modification 2002), published by the Lombardy Region itself in December 2002, has been in experimental use for the evaluation of DRGs. Since 1/1/2007 the annually updated hospital tariff system has been in use for the remuneration of acute surgical DRGs of specific interest for activity in the day surgery/one-day surgery setting versus ordinary hospitalisation. The previous regulations, which, in fact, prescribed that a sum equal to 75% of the entire value of the DRG treated in the ordinary hospitalisation setting be remunerated, has been revised in relation to certain diseases. In the present study we consider two different groups of DRGs pertaining to acute surgical diseases: DRGs remunerated equally for all three kinds of hospitalisation, and DRGs remunerated differently in day surgery/one-day surgery versus ordinary hospitalisation. From our experience it emerges that the percentage of elective operations in the short hospitalisation setting versus ordinary or 5% deferred emergency hospitalisation has stabilised around 20-25% in the two last years. Computerisation of waiting lists has also contributed to reducing mean waiting times, at the same time increasing the total number of operations per year.