Implementation of DRG-based healthcare reimbursement into the health insurance information system

This master thesis focuses on the development of a general method for the implementation of the CZ DRG classification system into the information system of a health insurance company to optimize business processes and efficiently calculate costs for reimbursement of inpatient care. The method is based on the analysis and collection of business requirements of insurance companies and provides a comprehensive solution for the implementation of this system. It uses the principles set out in the Business Analysis Body of Knowledge (BABOK) and is divided into several areas, including planning and monitoring, requirements collection, analysis strategy, requirements analysis, and solution design and evaluation. The paper also describes the different ways of reimbursing healthcare in the Czech Republic, including the legal framework, reimbursement decree and reimbursement mechanisms. In addition, the CZ DRG classification system and its functioning is presented, including the algorithm for classifying hospital cases. Verification of the proposed method was performed by implementing the CZ DRG system into the information system of a specific insurance company and by evaluating the impact on the existing system. Overall, this work provides a useful methodological approach for the implementation of the CZ DRG classification system, which can be used in any Czech health insurance company to streamline healthcare reimbursement processes and eliminate their shortcomings.