Data modeling for Health Insurance using DRG system in the Czech Republic

Hospitals and other health care establishments are collecting huge amounts of data about patients. With development of information technologies in 1960’s there was also progress in systems for efficient processing of these data. DRGs (Diagnosis Related Groups) was formed in USA among the first classification systems that categorizes hospitalization cases into groups, so that groups are homogeneous from the clinical and cost-related viewpoints. Categorized data serves for calculating fees charged for acute medical care. DRG system spread rapidly from USA to other countries (e.g. Australia, Austria and Germany) and since 1995 there were efforts to adopt the system also in the Czech Republic. In 2011 the new way of DRGs implementation into Czech health care system was developed by IBM Company to automate and streamline the algorithm of processing the data file with all cases of inpatients from the reference year. Since 2012 almost 75 % of the inpatient health care costs have been calculated using DRGs. This paper shows the possible use of statistical methods for the health care cost determination on the example of the Czech Republic. The outputs contain graphical representation and the selected characteristics of the data set with complete information about the inpatient care provided in 2010 in the Czech Republic.