Clinical Coding

Health system managers, no matter their context, rely on, and benefit from, accurate and timely information about the supply and the need for healthcare services. Among the most important health system management tools are patient classification and case-mix systems which enable the detailed quantitative characterisation of service demand and service need.

These tools use coded clinical data that define patient diagnoses and medical procedures, along with patient age and sex. On the service supply side, they use coded data that describes the providers of care, i.e. professionals and facilities, together with their locations, practice disciplines or practice types. Data on financial outcomes (costs) and clinical outcomes (reported by clinicians and patients) complete the picture.

In this two-part series, we explore patient classification systems, focusing on hospital-based diagnosis-related group (DRG) systems, the setting in which case-mix systems were first developed and have been adopted extensively into routine use, followed by a description of similar tools for primary healthcare (PHC).

The papers cover aspects of infrastructure, resources and steps needed for the development and implementation of case-mix analytic tools that could enable more effective and efficient primary healthcare system management.

Part one: Diagnostic-related groupers

Percept | January 2023 The utility and feasibility of diagnosis-related groupers for South Africa’s public health sector Part one provides context and background to DRGs, explaining how they are used and...