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From Hospital Building to Hospital System: How Structure, Organization, and Process Management Are Likely to Evolve in a Hybrid Era

Introduction A terminology of "monoliths" for "High-Complexity Hubs" and "swarms" for "Distributed Care Network" is evocative rather than standard in health-services research, but it captures a real and increasingly well-documented transformation. The academic and policy literature more commonly describes this transition as a move toward  centralization of high-complexity services  alongside  decentralization of appropriate care  through integrated, people-centred networks, telemedicine, hospital-at-home models, virtual wards, and hub-and-spoke systems. In that sense, the future hospital is not disappearing; it is being reconstituted as a  networked institution : centralized where rarity, risk, and capital intensity require concentration, and decentralized where continuity, accessibility, and lower-acuity care favor delivery closer to the patient. In this essay I want to argue that hospitals will evolve along three interlocking dimensions.  S...
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A Belgian Implementation Blueprint for WHO ICD-11/WHO ICHI-Based MDCs and DRGs in Relation to SNOMED CT

Abstract A defensible Belgian pathway to Major Diagnostic Categories (MDCs) and Diagnosis Related Groups (DRGs) based on WHO ICD-11 and WHO ICHI could be built as a three-layer architecture: SNOMED CT for point-of-care clinical semantics, WHO ICD-11 Mortality and Morbidity Statistics (MMS) and WHO International Classification of Health Interventions (ICHI) for classification of diagnoses and interventions, and a transparent national grouper that consumes standardized episode variables and produces reimbursement classes. That architecture should not assume the existence of an official global SNOMED CT→WHO ICD-11 or SNOMED CT→WHO ICHI reimbursement-grade map. WHO states that the outcome of WHO ICD-11/SNOMED CT mapping collaboration remains under discussion and is not guaranteed, while WHO’s ICD-11 licensing materials also state that mappings and crosswalks are not covered by the base WHO ICD-11 licence and may require separate written agreement. SNOMED International documents official ma...
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Implementing abuse and fraud detection in DRG-based payment: an integrated approach using analytics, patient-level costing, and evidence-based practice

1. Introduction Major Diagnostic Categories (MDCs) and Diagnosis-Related Groups (DRGs) underpin prospective (case-based) payment by assigning inpatient stays to clinically coherent groups and paying a predetermined amount based largely on a relative weight (resource intensity) multiplied by a standardized/base rate, with further policy adjustments (e.g., wage index, teaching, disproportionate share, outliers). Under Medicare’s Inpatient Prospective Payment System (IPPS), for example, the US  Office of Inspector General (OIG) in the USA describes the operational payment logic as “DRG weight × standardized amount,” with additional adjustments layered onto the base payment. Prospective payment improves cost discipline, but it also creates predictable gaming surfaces: when revenue depends on coded diagnoses/procedures and discharge status, some actors can increase payment by manipulating codes, fragmenting bills, or selecting “profitable” patients (cherry picking/lemon dropping). The ...
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Implementing patient-based costing to derive robust DRG weights for national reimbursement and hospital pathway management

Introduction Diagnosis-Related Group (DRG) payment systems depend on relative weights that approximate the average resource intensity of clinically coherent inpatient groups. When weights are weak - because costing is inconsistent, feeds are incomplete, or coding is unreliable - national tariffs can misprice care, destabilize provider incentives, and reduce confidence in performance analytics. In this essay I try to  synthesize established approaches to patient-level costing (PLICS/ABC/TDABC) and DRG tariff setting, drawing on documented national programs (e.g., England’s National Cost Collection, Australia’s AHPCS/NEP process, and Germany’s InEK cost accounting scheme), and propose an implementable framework to (1) produce reliable national reimbursement weights, (2) embed auditability via a practical controls checklist (General Ledger (GL)  reconciliation, feed completeness, allocation governance, coding QA/QC), and (3) operationalize patient-level costs for internal hospita...
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