Tuesday, April 16, 2024

Norway’s Healthcare Financing Evolution: 2024 Diagnosis-Related Groups System Unveiled

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In December 2023, the Norwegian Directorate of Health made a significant announcement that would have a substantial impact on the country’s healthcare system in the coming year. They released the final version of the Diagnosis-Related Groups (DRG) system, known as Innsatsstyrt finansiering (ISF), for the year 2024. The ISF is a crucial component of activity-based funding for the regional health authorities (Regionale Helseforetak or RHFs) through the national budget. While 2024 brought no groundbreaking changes to the system, it remains a fundamental pillar in the financing of healthcare in Norway.

The financing structure for the RHFs primarily comprises two components: a basic grant and activity-based funding, which is facilitated through the ISF. For the year 2024, the distribution remains consistent with the previous year, with the ISF accounting for approximately 40% of funding and the basic grant making up the remaining 60%. This financial framework provides stability and predictability while allowing for adjustments to accommodate the evolving healthcare landscape.

The Norwegian DRG system, ISF, is comprised of three integral parts:

  1. Diagnosis-Related Groups (DRG): These groups categorize patients with similar clinical conditions and treatment requirements, allowing for a standardized method of calculating reimbursement.
  2. Special Service Groups (Særtjenestegrupper or STG): STGs encompass specialist healthcare services that extend beyond traditional inpatient and outpatient settings. They often involve extended treatment periods during which patients take on more responsibility for their care. Examples of STG services include patient-administered peritoneal dialysis, hemodialysis, and telemedicine.
  3. Service Course Groups (Tjenesteforløps grupper or TFG): TFGs represent a higher-level aggregation above DRG and STG, providing financing for patient treatment courses that involve multiple stays and activities. These bundled payments help streamline the reimbursement process for complex treatments, such as dialysis or hip prosthesis insertion.

Healthcare

New Additions in Healthcare Coding

In the upcoming year, no new DRGs will be introduced, maintaining continuity with the previous year’s system. However, there will be notable additions in the form of one new STG for light treatment and five new TFGs. The introduction of these TFGs is primarily for data collection purposes and does not include specific tariff rates. Among the new TFGs, two examples include:

  1. PT11 Pregnancy and childbirth pathway with complicating factors.
  2. PT14 Pregnancy and childbirth pathway with resource-intensive interventions without complicating factors.

To calculate DRG/STG/TFG tariffs for somatic care in 2024, a cost weight must be applied to a base tariff of 52,248 NOK. This methodology ensures that reimbursements align with the complexity and resource requirements of the provided healthcare services, promoting fairness and efficiency in the system.

 

Resource: Med Tech Reimbursement Consulting, January 04, 2023

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