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Designing a DRG-based hospital reimbursement for efficiency, effectiveness, and high quality

Introduction Diagnosis Related Groups (DRGs) are a case-based hospital payment mechanism that converts coded clinical and administrative data into clinically meaningful, resource-relevant groups to determine prospective reimbursement. A well-functioning DRG system must simultaneously (i) classify patients fairly (clinical coherence and resource homogeneity), (ii) price cases credibly (cost accounting and weight setting), (iii) control incentives that can degrade quality or induce volume inflation, and (iv) assure data integrity through governance, auditing, and quality measurement. International experience - including long-standing US Medicare prospective payment - shows that DRGs can improve transparency and managerial efficiency but also create incentives for shorter stays, coding inflation (“upcoding”), and strategic behavior unless counterbalanced by strong expenditure controls, quality monitoring, and anti-fraud capacity. 1. Conceptual foundations DRG systems were developed to def...
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Process Mining in de gezondheidszorg voor de analyse van zorgpaden

Inleiding  Met de toenemende druk op de gezondheidszorg om beter om te springen met de beschikbare middelen, wordt het belangrijker om zorgprocessen efficiënt en effectief te organiseren. Dat geldt zowel voor de normale werking als in tijden van gezondheidscrisissen. Nog steeds worden theoretische modellen gemaakt van zorgpaden die niet overeenstemmen met hoe het er echt aan toe gaat op de werkvloer. Process Mining kan helpen om in kaart te brengen hoe een zorgproces in de praktijk verloopt, zodat theorie en praktijk beter op mekaar kunnen worden afgestemd. Proces Mining Process mining is een analysetechniek die IT-logbestanden (event logs) gebruikt om werkelijke bedrijfsprocessen te visualiseren, analyseren en verbeteren. Het maakt inefficiënties, knelpunten en afwijkingen zichtbaar, wat kan leiden tot efficiëntere processen, lagere operationele kosten en hogere patiënt- en medewerkerstevredenheid (change management).  Process mining in de gezondheidszorg analyseert d...
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Semantics, Ontology, and Syntax in Health Informatics: Conceptual Distinctions and Practical Implications for Hospital EHR Implementation

Abstract Implementing a modern Electronic Health Record (EHR) in a hospital is fundamentally an exercise in representing, exchanging, and reusing clinical information safely across time, teams, and systems. This requires clarity about three related but distinct notions: syntax (how information is structured and encoded), semantics (what that structured information means), and ontology (a formal, explicit specification of the domain concepts and relations that underpin shared meaning and enable computational reasoning). In this essay I want to distinguish these concepts and demonstrates how their differences translate into concrete design, integration, governance, and patient-safety considerations in real-world hospital EHR implementations. 1. Introduction Hospitals depend on EHRs not only to store a longitudinal patient record, but to coordinate care across departments (e.g., laboratory, pharmacy, radiology, admissions), across professions, and often across organizational boundaries...
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Managing Indicator Vulnerabilities in Healthcare: Mixed-Method Evaluation, Anti-Gaming Design, and Adaptive Metric Governance

Abstract Healthcare quality measurement routinely relies on structure (resources), process (actions), and outcome (results) indicators, often combined into broader “quality indicator” systems. While foundational, each indicator type is vulnerable to confounding, weak causal interpretability, data artifacts, and behavioral distortion when linked to accountability or incentives. Building on Donabedian’s framework for evaluating quality and modern guidance on measure evaluation and lifecycle management, this essay proposes a practical governance approach: (1) mixed-method evaluation that triangulates quantitative signals with theory-driven and qualitative inquiry; (2) anti-gaming measure design that anticipates Goodhart/Campbell effects and reduces manipulability; and (3) periodic reassessment that treats measures as adaptive social instruments requiring continuous validation, recalibration, and retirement. The central thesis is that credible quality assessment is not achieved by “bet...
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Co-creation of healthcare policy and healthcare innovation: strengths, weaknesses, mechanisms, and a governance model for measurable value

Abstract Co-creation (and related “co-production” and “co-design”) is increasingly used to shape healthcare policy and to accelerate innovation adoption by involving patients, citizens, clinicians, payers, regulators, and industry in joint problem framing, design, and evaluation.  Conceptually, co-creation can increase the relevance, legitimacy, implementability, and equity of innovation-supporting policies, thereby improving efficiency, effectiveness, quality, and outcomes. Empirically, however, systematic reviews repeatedly conclude that outcome evidence is inconsistent, under-measured, and often limited to process or experiential benefits rather than system-level value. This essay (i) synthesizes documented strengths and weaknesses of co-creation as a policy approach, (ii) maps these to mechanisms and real-world examples across three policy levels (national/regional; payer reimbursement; hospital/provider) and four innovation types (digital health; payment models; workforce rede...
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