Greek NHS: The new hospitals show the funding deficit

The country’s hospitals are expected to have debts of 1.3 billion euros by the end of the year. The debts concern 661 million euros for medicines and another 652 million euros for other expenses.

This amount is up by 4.6% this year compared to December 2022, when hospital debts reached around 900 million euros.

These figures are ascertained by the Hellenic DRG Institute, from the audits it carries out in hospitals, in view of the change in the financing of hospital care from 2024.

As from next March the funding of hospitals is expected from NHS-EOPYY, instead of the state budget – which is valid today – the Hellenic DRG Institute is gradually introducing new hospitals that reflect the full cost of each medical procedure to the hospitalized patients.

To do this, proper costing is needed, which is based on the detailed recording of the patient’s journey through the health system, especially from the moment he is admitted to the hospital.

The president of Hellenic DRG Institute Pantelis Messaropoulos

The new Diagnosis-related group (DRG’s) system which is expected to be fully implemented next March with reimbursement of hospitals by EOPYY will lead to an increase in the grant of the EOPYY with 80% of the funding currently foreseen for the state budget, so that there is the possibility of payments. A prerequisite, however, is the correct costing of the services provided, so that there are no problems in the funding flow of the nursing units during the initial period of implementation of the new system.

The new hospital system has already started to be implemented in the 7th Health Region (HRE) of Crete and the 3rd HRE of Western Macedonia, where from the end of November it is expected that payments from EOPYY will also begin, after the Ministry of Finance has signed the relevant joint ministerial decision. Then and until next March, all hospitals will join, from all the Ministry of Health of the country.

What the tests showed

So far, from the audits carried out by the Hellenic DRG Institute for the implementation of the new hospital system, 240,000 cases were initially examined, which were finally reduced to 133,000.

The first “package” of checks concerned approximately 67,000 cases from the hospitals of Crete. Of these, 45,000 incidents required rechecking. For the total of 133,000 incidents, re-checks were made in 95,000 incidents.

The audits showed incomplete updating of the patient’s medical file in a percentage of more than 30%, lack of practical operating room (25%) or information note (less than 15%), incomplete documentation of the need to be admitted to the hospital (10%), etc.

At a conference held at the Hellenic DRG Institute on Monday, November 13, the president of the Center, Pantelis Messaropoulos, pointed out that with the new hospitalizations that have been introduced, out of the 67,000 incidents, only 25% had been declared with the correct coding, covering 100% of the requests elements. In a percentage of 58% during the audit a series of observations were made, while changes were made in 17%.

Hospitalization

The primary reason for admission was correct in 95.3% and the secondary diagnosis was correct in 83.5% of cases, while a change of disease was required for 16.5%.

89.6% of the medical procedures performed were correctly declared, while there was also a 10.4% where the medical procedures performed had to be changed.

As for the selection of hospitals, 96.3% of DRG’s were correct and only 3.7% needed changes.

The biggest problem in choosing the right hospital was the cases of the Emergency Department, since there a change was needed in 8.6%, a rate more than double that of the other cases (3.7%).

Mr. Messaropoulos emphasized that there are more chances to change the hospital after the Emergency Rooms (EDRs), when the patient is admitted to the hospital for pathological or pediatric cases, as these cases are more complex and after the ER there is further investigation of the reason for admission.

Patient file

As medical procedures carried out in hospitals are part of the patient’s history, they should be filled in every detail in the patient’s electronic medical record.

But of the 66,000 incidents, it was found that there was no history for 4,500 incidents. Investigating the cause, the levels of KETEKNY found that finally only 20 cases were without a history, while the remaining 4480 related to chemotherapy, for which no history is recorded.

On the contrary there was no practical surgery plan for minor operations, such as hysteroscopies, cystoscopies, colonoscopies, etc.

From now on, however, it will be necessary to draw up a surgery practice before the patient is discharged for all operations, so that the hospital, by submitting the practice, together with the physical document and related information note, can be paid by EOPYY.