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Bu çalışmada Teşhis İlişkili Gruplar (TİG) Metodolojisi temel alınmıştır. Ayrıca sağlıkta geri ödeme sistemleri hakkında bilgi verilmiş, TİG’e dayalı finansman sistemlerinin tarihçesi, yapısı ve amaçları üzerinde durulmuştur. TİG oluşum süreci göz önünde tutularak TİG kodlarının nasıl oluşturulduğu anlatılmıştır. Uygulama kısmında, seçilen yedi kamu hastanesi TİG verileri kullanılarak, tarafımızca belirlenen bir global bütçenin bu hastanelere nasıl paylaştırılabileceği üzerine bir simülasyon yapılmıştır. Bu çalışmada 2013 yılı, Sağlık Bakanlığı tarafından TİG verilerinin hastanelerde aktif olarak toplandığı ve bu konuda bilgi birikimin yüksek seviyede olduğu için kullanılmıştır. Seçilen hastanelerde üretilen P65 (A, B, C, D) ve P66 (A, B, C, D) TİG Kodları üzerinde çalışılmış olup hesaplanan Geri Ödeme Katsayısı doğrultusunda hastanelere global bütçe paylaştırılmıştır. Çalışmanın sonucunda hastanelerin yaptıkları işlemler doğrultusunda oluşturulan Geri Ödeme Katsayıları dikkate alındığında seçilen 6. Hastane en yüksek geri ödemeye, 5. Hastane ise en düşük geri ödemeye hak kazanmıştır. Böylelikle hastanelerin yaptıkları kapsamlı ve maliyetli işlemler geri ödeme yapılırken dikkate alınarak daha hakkaniyetli bir sistem oluşturulmaya çalışılmıştır.
This study is based on the Diagnostic Related Groups (TIG) Methodology. The information on health reimbursement systems has also been given, focusing on the history, structure and objectives of TIG-based financial systems. It is described how the TIG codes are created, taking into account the process of formation. In the application section, using the selected seven public hospitals TIG data, a simulation was made on how a global budget determined by us can be shared with these hospitals. In this study, the year 2013 was used by the Ministry of Health because the TIG data was actively collected in hospitals and the accumulation of information on this issue was high. P65 (A, B, C, D) and P66 (A, B, C, D) TIG codes produced in selected hospitals have been studied and the global budget has been distributed to hospitals in accordance with the calculated refund rate. The results of the study are selected by taking into account the repaid rates created in accordance with the procedures that the hospitals perform. Receipt for the hospital, 5. The hospital has the right to pay back. Thus, a more fair system was tried to be created, taking into account the comprehensive and expensive operations the hospitals performed when refunded.
This study is grounded on the Diagnosis Related Groups (DRG) methodology. Also information about reimbursement system is given. Furthermore, the study lays stress on the history, structure and aims of the financing systems based on DRG. By taking the process of formation into consideration the development of the DRG codes is explained. By using the DRG data of seven public hospitals which are chosen through the reimbursement system methodology based on DRG, a simulation is made on how a global budget, which is determined by us, can be distributed to these hospitals. In this paper the data of 2013 is selected as in this year the DRG data is actively collected by The Ministry of Health and the high level knowledge on this issue exists. P65 (A, B, C, D) and P66 (A, B, C, D) DRG codes are analyzed in the chosen hospitals and the global budget is disturbed according to the calculated reimbursement parameter. As a result of the study when reimbursement parameters, which are developed according to the operations of these hospitals, are considered 6th hospital gains the highest reimbursement and the 5th hospital gains the lowest reimbursement. In this way, by considering the comprehensive and costly works performed by the hospitals during reimbursement, a fairer system is tried to be mapped out.
Alan : Sosyal, Beşeri ve İdari Bilimler
Dergi Türü : Uluslararası
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