Among the important activities of the Ministry of Health Monitoring Unit HMU is the introduction of clinical coding on diagnoses and procedures in the public hospitals. Clinical coding is essential for the proper pricing and costing of the hospital activities based on DRG system (Diagnosis Related Group).
“Diagnosis-related group (DRG) is a system to classify hospital cases into one of originally 467 groups, with the last group (coded as 470 through v24, 999 thereafter) being “Ungroupable”. This system of classification was developed as a collaborative project by Robert B Fetter, PhD, of the Yale School of Management, and John D. Thompson, MPH, of the Yale School of Public Health. The system is also referred to as “the DRGs”, and its intent was to identify the “products” that a hospital provides. One example of a “product” is an appendectomy. The system was developed in anticipation of convincing Congress to use it for reimbursement, to replace “cost based” reimbursement that had been used up to that point. DRGs are assigned by a “grouper” program based on ICD (International Classification of Diseases) diagnoses, procedures, age, sex, discharge status, and the presence of complications or comorbidities. DRGs have been used in the US since 1982 to determine how much Medicare pays the hospital for each “product”, since patients within each category are clinically similar and are expected to use the same level of hospital resources. DRGs may be further grouped into Major Diagnostic Categories (MDCs). DRGs are also standard practice for establishing reimbursements for other Medicare related reimbursements such as to home healthcare providers.” Source: https://en.wikipedia.org/wiki/Diagnosis-related_group
Health system characteristics and reforms:
Currently, Cyprus lacks a universal national health care system. A large part of the population (c.83%) has free access to the public health system, while those that are not eligible pay for services received in accordance with the fee schedules set by the Ministry of Health. In 2001, the Cyprus Parliament passed a law to introduce a NHS based on the establishment of a universal health insurance system financed by health insurance contributions and public funds, promoting at the same time competition in the public and the private sector. Following the passing of the law, the Health Insurance Organization was set up to oversee implementation of the NHS but this has been delayed for well over a decade.
In 2012, the government reaf rmed the road map for the implementation of health care reforms aiming at universal coverage with long term nancial sustainability. The road map encourages the development of policies for greater ef ciency and effectiveness of health care resources with closer public–private partnerships, gate-keeping, Diagnosis Related Groupings (DRG’s), user charges and measures aiming at the overall improvements in the performance of the health system.
Under the conditions included in the most recent revision of the MoU, the implementation of the NHS is considered as a key pillar of actions to be taken to address the existing challenges and reverse the negative course of the health care sector in Cyprus.
According to the MoU, the NHS will be implemented and anticipated to be fully in place in 2017. The relevant authorities are expected to take a decision on the nal design of NHS and adopt the relevant legislations according to a timetable that will ensure implementation of the NHS in 2017. As prescribed in
the MoU, the Cypriot authorities should have already adopted the hospital autonomisation bill and submitted it to the House of Representatives. While the Ministry has released draft bills, they that have not yet been adopted.