Final Action Plan for the Implementation of DRGs-Based Payments
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Washington, DC
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Bulgaria under the guidance of the
Minister of Health is undertaking a major reform of its
health system. One input to the reform is a joint study with
the World Bank on health financing in Bulgaria (The World
Bank Diagnostic Report). The report evaluates the strengths
and weaknesses of Bulgaria’s health financing system in
terms of the three health financing functions of revenue
raising, risk pooling, and purchasing of services. It
assesses each of these financing functions in terms of the
health financing goals of improving health outcomes,
financial protection, and consumer responsiveness in an
efficient, equitable, and sustainable manner. The assessment
of the health financing system documented significant
strengths in the system, but also major challenges in terms
of the purchasing function and current hospital payment
practices. These challenges included unsustainable growth in
hospital spending; lack of incentives for efficiency,
quality, or cost control, and strong incentives for
hospitalization over treatment in less expensive outpatient
settings. Fundamental problems with the current hospital
payment system using Clinical Care Pathways (CCPs) were
highlighted. The purpose of this report is to provide
information to Bulgarian decision-makers on how Bulgaria can
move towards implementing a DRG-based hospital budgeting and
payment system. The report was prepared by a team of
Bulgarian and international DRG experts who have been
involved in the country’s DRG assessment and planning since
its inception. The report is intended for a wide-ranging
audience that includes high-level policy-makers who are
weighting the benefits of implementing DRGs, technical staff
who may be tasked with implementing the Action Plan, and
other key stakeholders who may be less familiar with the use
of case-mix as a mechanism to provide payment to hospitals.
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