Hospital payment system based on diagnosis related groups in Italy: early effects on elderly patients with heart failure

Prospective payment systems (PPS) based on diagnosis related groups (DRG) has recently been introduced in Italy and has already changed certain practice patterns of medical staff. Treatment of chronic diseases and those which specifically address the elderly population, such as chronic heart failure (CHF), can be strongly conditioned by this kind of system. This paper concerns an overview of CHF patients within the DRG system, supported by age-related variables, re-admission rates and cost analysis. We analyzed a sample of four hospitals in Central Italy and 1987 patients were admitted for CHF. The results show that after DRG introduction, length of stay was shorter, but re-admission rate increased, especially where the elderly were concerned. Average costs of service provision decreased, mainly due to the reduction in length of stay. However, no reduction was reported in the quality of care in terms of available diagnostic and the rapeutic resources. These early data indicate a change in the practice patterns of medical staff, including the risk of untimely discharge of elderly patients suffering from chronic diseases, for whom a long term monitoring system of service quality would be necessary.