Development and Implementation of the Dutch DRG System

PROJECT DETAILS

CLIENT

Ministry of Health Netherlands / Nederlandse Zorgautoriteit

REGION

Netherlands

YEAR

2006–2010

SERVICE AREAS

Funding & Reform

National Policy

Governance

Case Study.pdf

Situation

In 2002 a DRG system was introduced in the Netherlands that proved far too complicated — with over 30,000 DRGs, no uniform diagnosis classification, vulnerability to overcoding and significant administrative burden for providers. The system was fundamentally flawed and required complete redesign while maintaining stakeholder confidence and political support

Challenge

All stakeholder representatives wanted a fundamentally revised system but simultaneously resisted giving up their influence on its design — creating contradictory design criteria. The system needed to meet international standards while retaining Dutch-specific elements, within a tight government timeline.

Action

Programme transformation

Transformation of the maintenance organisation into a structural development, design and implementation organisation.

Stakeholder management & design criteria

Setting up international design criteria and aligning the Ministry of Health and Dutch Health Authority.

R&D lab

Setting up the R&D lab for diagnosis and activity classification, costing, and time/material simulation.

Technology implementation

Management of technology implementation at provider and payor side, including political stakeholder management.

Result

New DRG system developed and accepted by all national stakeholder organisations — implemented and still the national reimbursement vehicle after 14 years

Based on ICD-10 and a single activity-based costing system, accepted by all stakeholders.

Implemented across all providers and payors nationwide.

Stable basis for Dutch healthcare costing for 14+ years, with no major implementation issues.

Covers €22B in acute specialist care and €5B in mental health care.

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