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Diagnosis-related groups in Europe: Moving towards transparency, efficiency and quality in hospitals?

Busse R, Geissler A, Aaviksoo A, Cots F, Häkkinen U, Kobel C, Mateus C, Or Z, O’Reilly J, Serden L, Street A, Świderek M, Tan SS, Quentin W
BMJ 346: f3197





Hospitals in most European countries are paid on the basis of diagnosis related groups. Reinhard Busse and colleagues find much variation within and between systems and argue that they could be improved if countries learnt from each other

Diagnosis related groups (DRGs) were originally developed in the 1970s by researchers at Yale University.1 Their aim was to define “hospital products” and to measure what hospitals actually do.2 Medicare in the United States soon realised the potential of DRGs for paying hospitals for their work and introduced the first DRG based payment system in 1983. Since then, DRGs have spread around the world, gradually becoming the basis for paying hospitals in most industrialised countries, particularly in Europe.3 Even though hospital doctors in Europe are salaried rather than paid by DRGs, their clinical decisions largely determine the income of their hospitals and their specialist societies can influence the way DRG systems work. We recently reviewed the experience with DRG systems in 12 European countries,4 and here we compare the differe

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