Strengthening the DRG reimbursement system in Chile

Abstract

In 2020, FONASA created the Diagnosis-Related Groups (DRG) to finance 65 hospitals. In 2021, the limited subsidy fund was incorporated for five device groups, in order to adequately reimburse the costs derived from medical devices. The objective of this article was to review the budget execution of the limited subsidy fund in its first year of implementation and to submit recommendations for public policies. 50.31% of the expected discharges were covered and 60,35% of the fund was used (M$10,784,377). Devices with fewer expenditures than expected were coils (-14.51%), aortic endoprosthesis (−24,42%), and knee and hip prostheses (−55,99%). Those with higher expenditures were devices with and without cardiac resynchronization (+33,55% and+42,78%). FONASA was responsive to the activity reported to define the fund for 2022 (Spearman 0.955, p=0.015). An underexecution of the budget of the fund is observed. Limited subsidy funds are short-term tools that encourage innovation. It is likely that, in its first year, the pandemic, coding issues, and unawareness of the fund, etc., could explain these findings.