Impact of hospital provider payment reforms in CroatiaCroatia began to implement case-based provider payment reforms in hospitals beginning in 2002, starting with broad-based categories according to therapeutic procedures. In 2009, formal diagnostic related groups were introduced, known locally as dijagnosticko terapijske skupine. This study examines the efficiency and quality impacts of these provider payment reforms globally on the Croatian health system by analyzing data on five procedures in acute health care for 10 years, between January 2000 and December 2009. The five procedures are cataracts, pneumonia, coronary bypass, appendectomy, and hip replacement. Using data from the Croatian Institute for Health Insurance, this study finds that both broad-based and detailed case-based payment systems have improved efficiency as measured by a reduction in average length of stay, with little impact on the number of cases. These provider payment reforms have had no adverse impact on quality as measured by readmissions. While it is still too early to quantify the impact of Croatia's introduction of formal diagnostic related groups, it appears that the introduction of both broad and detailed case-based payment systems has improved efficiency in acute hospital care.
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