|Case type:||Major||Owner / responsible:||National organisations|
|MDC:||GEN||Old forum status:|
A desired development within activity-based funding in Norway is a shift towards funding episodes of care instead of single visits. We have developed new groups called TFG (Tjenesteforløpsgruppe). This groups may include stays categorized in different DRGs and often also combined with activity in STGs (Særtjenestegrupper – see case ##). These TFGs are constructed as a level above the DRG and STG and is based on these classifications. As the activity-based funding is done yearly and for the specialized health care sector only, this TFGs are not covering all the patients contact on a specific matter (not a full "episode of care").
An illustration of the design of groups and relation to DRG and STG is enclosed, as well as a list of the TFGs.
From 2019 we have implemented TFGs on two main areas, dialysis and drug treatment. The dialyses category will include both dialyses done in hospitals and at home. For drug treatment we have included four areas. Expensive biological drug treatment for neurological disorders, gastrointestinal disorders, rheumatoid disorders and skin disorders. The activity-based funding for this groups is based on calculated average costs (KPP data) per DRG and STG, and these are weighted together to a new average cost per patient per period per service cycle (TFG). This will give the same activity-based funding from the government to the regions regardless of whether the patient is being treated at home or in hospital.
This will provide more flexibility in choosing the best and most cost-effective treatment for each patient group.
This case is mainly reported as information to other countries, but we also appreciate any comments you might have on this issue.
#1 Updated by Ralph Dahlgren 4 months ago
2019-02-19 Ralph Dahlgren
This is something that Finland has developed. But how it is done in Finland on a detaliled level has been given no information about. So this time I ask Norway, is it possible to se on a detail level how you contruct these TFG (Tjenesteforløpsgruppe). Because even if they are not that many once the thinkiong behind the contruction is done it is possible to make new ones. When I say detail level I mean for example the ICD-10 kodes, procedure codes, how time limits are decided, which contacts are included, which are not and why so, can an episode cross a yearline (2019-2020)?
I am sure there is alot of work done with this, alot of document that lays behind this so if they are public is it possible that you could put them on Forum or send them to me?
#3 Updated by Kristin Dahlen 4 months ago
The episodes are only built on the specialized care visits, inside or outside hospital. The primary care activities are not included. As these groups are made for activity based funding of the hospitals (regions) they are limited on a yearly basis. However, there are no such limitations in the logic, so if we use a datamaterial for several years it may be a technical possibility to make even longer episodes.
As you can see from the picture following this case, the TFGs are based on the classification done by the DRG og STG system. We make a grouping to DRG and STG as before, and aggregate to TFG based on information about DRG and STG. The TFG for dialyses are based on the patients episodes in DRG 317, 317O, STG MS01 and STG MS02. The drug treatment TFG for reumatological deseases are made on a patients episodes in DRG 808H and STG HS01.
For more information see [[https://helsedirektoratet.no/Documents/Finansieringsordninger/Innsatsstyrt%20finansiering%20%28ISF%29%20og%20DRG-systemet/ISF%202019/ISF%202019%20-%20Grunnlagsdokumentet.pdf]]. For even more detailed information we have a couple of reports available.
#7 Updated by Martti Virtanen 3 months ago
- Status changed from Active to Rejected
2018-03-11 Expert group
This case is an important dicussion area and it is important that the work is reported to others in the collaboration. Norway will continue to work with the issue and eventually report later.
Since the case does not result in any change, it is formally rejected and thus closed.