2015 № 6 Reform of financing system of hospitals in the Republic of Moldova
Until the implementation of the MHI health system in the Republic of Moldova, the health system was financed under a guaranteed minimum by the state, the rest of services being provided for paying services. This led to a serious degradation of the health system infrastructure and to a significant reduction of the access to health services. The situation was particularly unsatisfactory in the hospital sector. To redress the situation, with the MHI implementation, for financing the hospital care was proposed switching to the mechanism of payment «treated case by profile». Following the implementation of this mechanism has been increased significantly the productivity of hospital institutions manifested by increased levels of hospitalization for insured persons from 138 to 249%, the increase of share of using bed from 75,4 to 87,7 % etc. In 71,2 % of the leaders opinion of hospitals, the increase of hospital productivity was the result of the influence of used payment method. However, the mentioned method of payment has a number of drawbacks, the most important being that it had admitted a large disparity between costs within profile cases. To solve this problem, the method of funding per treated case was improved by switching to DRG. The rationale of switching to this method was made by comparing the logic assignment of cases to the group, but also by comparing the number of groups and cost differentials profiles encountered in contracted hospitals at the district level. To estimate the impact of the use of DRG on hospital activity were investigated: the number and provided complexity index cases, the number of operations and procedures carried out and a number of other indicators. Implementation of the DRG in Moldova has resulted in an increase in the number of cases rendered by 5%, the index of complexity of the case with 11,9%. Also, the average length of stay decreased by 7,4%.